Application Form for Volunteer Counselor Position
| You must be at least 14 years old to apply.
Enter n/a for those fields that do not apply to you. |
| First Name |
|
| Last Name |
|
| Email |
|
| Address |
|
| City |
|
| State |
|
| Zip Code |
|
| Phone |
xxx xxx-xxxx |
| Gender |
|
| Age |
|
| Birth Date |
mm/dd/yy |
| Sessions Desired |
|
| School Attending |
|
| Grade Completed |
|
First Aid Certification
(If yes, send a copy of your card with the required medical form) |
|
CPR Certification
(If yes, send a copy of your card with the required medical form) |
|
| Have you worked previously at Camp Smile? |
|
If you selected Yes to the question above,
give dates. |
|
| Have you ever been convicted of a felony or misdemeanor? |
|
If you selected Yes to the question above,
give dates and convictions. |
|
| Have you ever been convicted of a child abuse or a sexual offense? |
|
If you selected Yes to the question above,
give dates and convictions. |
|
| References: Please give references to persons (not relatives) who have knowledge of your character, experience and ability. |
| Reference Number 1 |
| Reference 1 - First Name |
|
| Reference 1 - Last Name |
|
| Reference 1 - Address |
|
| Reference 1 - City |
|
| Reference 1 - State |
|
| Reference 1 - Zip Code |
|
| Reference 1 - Phone |
xxx xxx-xxxx |
| Reference Number 2 |
| Reference 2 - First Name |
|
| Reference 2 - Last Name |
|
| Reference 2 - Address |
|
| Reference 2 - City |
|
| Reference 2 - State |
|
| Reference 2 - Zip Code |
|
| Reference 2 - Phone |
xxx xxx-xxxx |
| Reference Number 3 |
| Reference 3 - First Name |
|
| Reference 3 -Last Name |
|
| Reference 3 - Address |
|
| Reference 3 - City |
|
| Reference 3 - State |
|
| Reference 3 - Zip Code |
|
| Reference 3 - Phone |
xxx xxx-xxxx |
| Parent/Guardian Information |
| Parent/Guardian 1 (Father) - First Name |
|
| Last Name |
|
| Work Phone |
xxx xxx-xxxx |
| Cell Phone |
xxx xxx-xxxx |
|
| Parent/Guardian 2 (Mother) - First Name |
|
| Last Name |
|
| Work Phone |
xxx xxx-xxxx |
| Cell Phone |
xxx xxx-xxxx |
|
| Emergency Contact - First Name |
|
| Emergency Contact - Last Name |
|
| Emergency Contact - Address |
|
| Emergency Contact - Phone |
xxx xxx-xxxx |
|
| Explain briefly why you wish to be a counselor at Camp Smile: |
|
| Please list any special talents, interests, or hobbies or past counseling experiences you would be willing to share as a counselor. |
|
| Give two suggestions for new/different activities (games or crafts) that you could share with campers.
If you are a former counselor, which activities were effective? Which do you think should be dropped? |
|
|
|
|
