Counselor Application

Address

Phone Number
Area CodePhone Number
E-mail
Do you check your email daily?
YesNo
Grade Entering 2020/2021
School/College 2020/2021
List dates you're available this summer
Are you CPR certified?
YesNo
Are you qualified to give swim lessons?
YesNo
Describe all previous experience that you have had with children ages 5-13. Specify the role that you played, the ages of the children, and how often you helped care for them.
Share any skills, talents, and certifications you have that could be utilized in our camp.
Have you ever had a school suspension or expulsion? If so please provide history and details.
Have you ever had a delinquency adjudication? If so please provide history and details.
Have you ever been convicted of an assault or other offense? If so please provide history and details.
Reference #1
Name (Reference #1)
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to applicant
Reference #2
Name (Reference #2)
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to applicant
Signature
Date of Signature
MonthDayYear
Should be Empty:

This page uses TLS encryption to keep your data secure.

Camp Gan Izzy Counselor Application Form