New Staff Application - Camp Ba Yo Ca

Camp Ba Yo Ca | Office: (865) 453-6274

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New Staff Application

Dear applicant,

1. fill out completely
2. will contact for interview
3. questions? call or email.

Personal Information

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Social Security Number *

Parent's Name *

Parent's Phone Number *

Sex *

Age *

Birthday *

School You Attend *

Grade *

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

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