New Staff Application

Dear applicant,

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

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) *

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 *