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Safety Camp Junior Counselor

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Safety Camp is June 5-9, 2023 from 9-12pm
First Name*
Last Name*
Date*
Date
Date
Address1*
City*
State*
Zip*
Phone Number*
Parent Email*
Date of Birth*
Age as of June 5, 2023*
Emergency Contact*
Emergency Contact Phone Number*
Emergency Contact Relation*
Have you worked as a Junior Counselor before? *
1. Yes
2. No
Why do you want to be a Junior Counselor at Safety Camp? *
List any former or current employment experience. *
List any qualifications and extra-curricular activities. *
References (teachers, clergy, former employees, coaches, etc. )
Name*
Phone Number*
Years known?*
Name*
Phone Number*
Years known?*
Name*
Phone Number*
Years known?*
Applicants and parents must understand that this program does not exist as a day care program. Those that are accepted into the program will be treated as camp staff and are expected to act as such. C.I.T.’s that do not follow the staff rules and behave as campers will be immediately dismissed from the program with NO refund.
Please select "Yes" or "No" if you agree with the above statement and agree to abide by staff rules. *
1. Yes
2. No