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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
Connect
Contact
Newsletter
About
Meet the Director
Our Program
Our History
UA-46977800-1
