2017 Counselor / Staff Application
If at any time you have questions regarding this form, please contact Jereme Miner, Camp Director at:
apply@clarksvillecamprainbow.org or 931-320-3473.
Last Name
Your answer
First Name
Your answer
Middle Name
Your answer
Age
Your answer
Gender
Required
Birth Date
MM
/
DD
/
YYYY
Home Address
Street:
Your answer
City:
Your answer
State:
Your answer
Zip:
Your answer
Employer
Employer Name:
Your answer
Work Phone:
Your answer
Your Contact Info:
Home Phone:
Your answer
Work Phone:
Your answer
Cell Phone:
Your answer
Email Address:
Your answer
Emergency Contact
Name:
Your answer
Home Phone:
Your answer
Work Phone:
Your answer
Cell Phone:
Your answer
Email Address:
Your answer
If 2017 will be your first year as a counselor or staff member, please complete the following question:
For background check only, please enter your Social Security Number:
Your answer
General Questions
Have you been a Camp Rainbow counselor before? If yes, how many years?
Your answer
Have you been a Camp Rainbow staff member before? If yes, how many years?
Your answer
Do you have a personal reference in Camp Rainbow or where you work that we could contact? If you know someone at Camp PLEASE list: If no, type NA
Your answer
What talents or interests do you have that will help us at Camp? (Please check as many as you want. For items requiring lists and/or explanations please use the textbox below.)
For items requiring lists and/or explanations please use this textbox.
Your answer
Do you have any physical disability that would prevent you from lifting a wheelchair-bound child:
Required
Do you have a camper age preference? If yes, please list.
Your answer
Can you be available from noon June 11th - noon June 17th?
Required
Do you have a request for a specific Camp duty? If yes, please explain.
Your answer
Do you have a request to be assigned to a specific camper? If yes, who?
Your answer
Do you have any comments or suggestions for Camp?
Your answer
Please tell us why you want to be involved with Camp Rainbow 2017
Your answer
Does Camp Rainbow have permission to use your name and picture for publicity or public service announcements on televisions, newspaper, radio, and other media?
Required
THE SIZE YOU PICK IS THE SIZE YOU GET!!
What is your shirt size?
Required
Sweatshirt Size?
Required
All information provided above is correct and I understand that I may be subject to a personal background check.
Terms and conditions: by checking the box thereby agreeing, I certify that I am the person identified in this application and that all information provided herein is true and correct. I further acknowledge that I have read and understand this application and all attachments. I understand that incomplete or false answers may be grounds for ineligibility or termination. I understand that an electronic signature has the same legal effect and enforceablility as a written signature on an application.
Do you agree to the terms and conditions?
Required
Please type your name:
Your answer
Date:
Your answer
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