Counselor Application Form 2026
Not for JC's (9th and 10th graders). JC application is the regular camper application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Email Address
*
Birth Date
*
/
Month
/
Day
Year
What grade are you in?
*
Current Yeshiva
*
Who can we contact as a reference?
*
Available Starting
*
-
Month
-
Day
Year
Date
Available Until
*
-
Month
-
Day
Year
Date
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Format: (000) 000-0000.
Physician Name
*
Physician Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
List all previous camp work experience
*
List Any Allergies
Why do you want to work at this camp?
*
Any additional questions or comments, please let us know
Submit
Should be Empty: