Counselor Application

Please fill out the form below and press "submit" to send us your application.

Date of Birth

Desired Sessions

Week 1

Week 2

Week 3

Week 4

Background

Select the highest level you've completed.

Yes, I have worked at Camp Smile before.

Have you ever been convicted of a felony or misdemeanor?

Yes

Have you ever been convicted of a child abuse or a sexual offense?

Yes

Certifications

Yes, I am First Aid certified.
If yes, please send a copy of your card with the required medical form.

Yes, I am CPR certified.
If yes, send a copy of your card with the required medical form.

Yes, I am Lifeguard certified.
If yes, send a copy of your card with the required medical form.

Parents/Guardians

Provide information of at least one parent/guardian.

Emergency Contacts

You must provide a back-up Emergency Contact unless there are multiple parents / guardians listed in the previous section.

Transportation

I am interested in bus pick-up / drop-off.

I will arrange for my own transportation.

I will drive myself.

References

* New counselors must complete this section (optional for returning counselors).

Provide three adult references (not relatives or peers) who have knowledge of your character, experience and ability.

Email this Parent/Guardian updates and communications from Camp Smile

Mother's Day Roses