Home
Summer Program
Summer Camp
Parent Info and Forms
Summer Staff
Retreats
Give
T-shirt Fundraiser
Connect
Blog
Contact
Newsletter
About
Meet the Director
Our Program
Our History
New Staff Application
Dear applicant,
1. Fill out completely
2. We will contact you for an interview
3. If you have any questions, feel free to give us a
call
or send us an
email
.
Personal Information
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Upload Recent Picture
*
Max file size: 20MB
Phone Number
*
Email
*
Social Security Number
*
Parent's Name
*
Parent's Phone Number
*
Sex
*
Male
Femal
Age
*
Birthday
*
School You Attend
*
Grade
*
Freshman
Sophmore
Junior
Senior
Other
Health Information
Tetanus (Booster Recommended every 10 years after initial immunization)
*
Polio (1963 oral series sufficient or at least 4 by kindergarten)
*
Is applicant subject to:
*
Diabetes
Nosebleed
Earache
Headache
Frequent Colds
continued
*
Abscessed Ears
Stomach Upsets
Sleepwalking
Asthma
continued
*
Fainting
Sore Throat
Sinusitis
Bronchitis
Serious Allergy
*
Bee Sting
Poison Ivy/Oak/Sumac
Other
Please List all Know Allergies
*
Please List Any Medications to be Taken (This must be administered by the camp nurse while at Camp.)
*
Please: 1. Explain any health problems (physical or psychological). 2. Fully explain any other important health related information. 3. List any activity restrictions
*
Emergency Contact
*
First
Last
Emergency Contact's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Emergency Contact's Phone Number
*
Submit
Home
Summer Program
Summer Camp
Parent Info and Forms
Summer Staff
Retreats
Give
T-shirt Fundraiser
Connect
Blog
Contact
Newsletter
About
Meet the Director
Our Program
Our History
