Date *
Date
Name *
Name
Permanent Address *
Permanent Address
School Address
School Address
Until?
Until?
When is the last date you can be reached at this address?
Mobile Phone Number
Mobile Phone Number
Home Phone Number *
Home Phone Number
Date of Birth *
Date of Birth
Male Female Other
Do you have a driver's license? *
Are you authorized to work in the US? *
Have you ever been arrested or convicted of a crime or offense, either felony, misdemeanor, or traffic misdemeanor? *
Are there any times/dates that you must take off from work this summer? *
Please list dates attended, college, major, present grade level, and degree
Please list dates, camps, addresses, telephone numbers, supervisors/directors, and your position both as a camper or staff. List most recent first.
Date, Company, Supervisor, and Position
Activities
Which activities do you feel comfortable leading? *
Which of the following activities do you feel comfortable assisting? *
Additional Information
Earliest date you can arrive at CYJ? *
Earliest date you can arrive at CYJ?
(Counselor Orientation begins June 22. Camp ends on August 18)
References
1. References *
1. References
Phone Number *
Phone Number
2. Reference *
2. Reference
Phone Number *
Phone Number
3. Reference *
3. Reference
Phone Number *
Phone Number
Additional Questions
By submitting this application, I authorize investigation of all statements herein and release the camp and all others from liability in connection with same. I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.