Camp Counselor Application
To be a camp counselor, you must be at least:
-16 years old for Little Shots
-18 years old for Middle Shots
-21 years old for Big Shots

Please fill out all information to the best of your knowledge.
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Email *
Legal First Name *
Legal Last Name *
Gender *
Street Address *
City *
State- Please spell out full name. *
Zip Code *
Phone Number *
Email address- Please use one you check often. *
Birthdate *
T Shirt Size *
Position you are applying for:
Note: This application is only for those interested in being a Hot Shots Camp counselor. If you are interested in another position at camp, visit to fill out the correct application for you
Nutritional Information
Please fill out to the best of your ability.
Do you have Celiac disease/gluten intolerance? *
Do you have any allergies? *
If you answered yes, please specify any allergies.
Please list any other dietary restrictions/accommodations.
Education Information
Please answer to the best of your ability.
If you are in college, what if your major and anticipated graduation date?
List any certifications you have, certification ID and expiration date. *
Please answer to the best of your ability.
Which camps are you able to participate in? Select all that apply. *
I prefer to work with:
Note: This question does not guarantee you will be with the age group requested, we will try our best to accommodate your preference. 
Have you been a counselor at Hot Shots camp in the past? *
Reference Information
When listing references, please list only professional references- no family members, friends, etc.
Reference #1 Name *
Reference #1 Phone Number *
Reference #1 Email *
Reference #1 Relationship *
Reference #2 Name *
Reference #2 Phone Number *
Reference #2 Email *
Reference #2 Relationship *
Additional Items
Please answer to the best of your ability.
Do you have Type 1 diabetes? *
Please indicate your current vaccine status. *
Have you even been convicted of a felony? *
Please list any physical restrictions that you have. *
Why do you want to be a counselor at Hot Shots Camp? *
Do you have any special skills you can bring to camp (yoga, crafty, camp song knowledge, etc.)? *
Liability Waiver
The above information is true to the best of my knowledge. I authorize investigation of all statements herein and release Diabetes Youth Services and all others from liability in connection with same. I understand that if employed, I will be an at-will employee. I understand that untrue, misleading, omitted information herein may result in dismissal, regardless of the time of discovery by Diabetes Youth Services

Waiver: In consideration of Diabetes Youth Services permitting me to participate at Diabetes Youth Services Camp, and acknowledging that activities while at camp have inherent risks, on behalf of my heirs, executors, administrators and assigns, I hereby waive, discharge, and release any and all rights claims for damages, losses or expenses which I may have against Diabetes Youth Service, Recreation Unlimited, Sylvania Park District/Olander Park, ProMedica Farms, or any other camp facility and their management, as well as any other person connected with Diabetes Youth Services Camps or as a result thereof. I hereby give Diabetes Youth Services, their legal representatives or assigns and those acting under their permission and upon their authority, permission to use my picture, and if desired, my name in advertising and in all forms of publicity, without limit as to time. I further release Diabetes Youth Services from any liability for what I might deem misrepresentation of be by virtue of alterations, optical illusions or faulty mechanical reproduction in such advertising and/or publicity.

 I further acknowledge that while Recreation Unlimited, Olander Park, and ProMedica Farms have COVID-19 protocols in place, and while DYS staff and volunteers also will be asked to follow COVID-19 protocols, DYS cannot guarantee that I will not contract COVID-19 while at a DYS camp or during registration and transportation to and from camp, and that there is an inherent risk of contracting COVID-19 by attending camp, and I hereby waive any liability against DYS for the same.

If you have any questions, please contact:

Cindy Presser
DYS Program Director
By typing your name below you understand and agree to the above waiver. A background check and drug screen are mandatory to be considered as a camp staff member. *
Thank you for your application!
A background test and drug screen are required to be a part of Hot Shots Camp. All applications are due by April 15, 2023. You will receive an email with more information after the final deadline.
A copy of your responses will be emailed to the address you provided.
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