Youth Counselor Form

Summer Camp Youth Counselor

Meck Investment Summer Impact Camp is seeking Youth Counselors who are rising high school seniors up to 23 years old. To be eligible for the $250.00 scholarship, community service hours, and/or a letter of recommendation, Youth Counselors must be pursuing higher education or a career path, attend every day of camp, and arrive on time each morning to greet campers. Counselors are expected to serve Monday through Friday, 8:00 AM–4:00 PM, from July 20th through July 24th on the campus of Johnson C. Smith University. Each year, the camp welcomes 300 young men ages 8–13 from the Charlotte area for an unforgettable week of mentorship, enrichment, and fun. Youth Counselors will help support daily activities, sports events, lunch distribution, and help create a safe, positive, high-energy experience for every camper. If you’re ready to show up, pitch in, and make a real IMPACT, we’d love to have you join us!
Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Birthday

MonthDayYear
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this the first time being a Youth Counselor for a summer camp?
Have You previously attended or volunteered at Impact Camp?

Please select one option below

Rows	CARRER PATH
TRADE SCHOOL
MILLITARY
COLLEGE/UNIVERSITY
EMPLOYED

Are you currently facing any criminal charges that may affect your ability to safely work with children or serve as a youth counselor volunteer?
Have you ever been convicted of, pled guilty to, or pled no contest to any offense involving harm to a child, violence, sexual misconduct, abuse, neglect, theft, drugs, or any offense that may affect your ability to safely work with children?
I certify that I have read this entire form carefully and that all information I provided is true, complete, and accurate to the best of my knowledge. I understand that providing false, incomplete, or misleading information may result in denial of my youth counselor volunteer application, removal from the program, and/or loss of eligibility for the $250 scholarship. I also understand and agree to the background check consent, scholarship requirements, and all acknowledgments listed in this form.
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