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

Please select the highest level you've completed.

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.

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

Emergency Contacts

Parents/Guardians

References

Please give references to at least three persons (not relatives) who have knowledge of your character, experience and ability.

Please email this Parent/Guardian updates and communications from Camp Smile