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Summer Camp Jr. Counselor 2024
Junior Counselor Registration Form
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Full Name
*
Your answer
Nickname
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Cell Phone Number
*
Your answer
School Attending and Grade
*
Your answer
Parent or Guardian Name(s)
*
Your answer
Parent or Guardian Cell Phone Number(s)
*
Your answer
Home Address
*
Your answer
Age
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Number
*
Your answer
Physician's Name
*
Your answer
Physician's Phone Number
*
Your answer
In the unlikely event of an emergency, I authorize DSACNJ/Club DREAMS to call emergency services on my behalf.
*
Yes
No
Required
Have you ever worked with children?
Please explain in detail.
*
Your answer
Have you ever worked with someone with special needs?
*
Your answer
Interests or Hobbies
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Your answer
PHOTO RELEASE - I give permission for DSACNJ/Club DREAMS to use my child's photo for advertising, promoting or marketing their organization, center or the Camp Program.
*
Yes
No
I'm interested in volunteering for the following Summer Camp options
*
One full week
Multiple weeks
Once a week
More than once a week
Required
Please indicate which week or weeks you would be interested in volunteering. Even if it is only one day during said week.
*
July 1-5th -we will be closed on Thursday, July 4th)
July 8th-July 12th
July 15th - July 19th
July 22nd- July 26th
July 29th- August 2nd
August 5th - August 9th
August 12-16th Full Day
Required
If over 18, a background check will need to be completed. Are you willing to have a background check run?
*
Yes
No
N/A
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