Camp Counselor Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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*

*Interesting in becoming an Early Admission Resident Counselor (EARC)? Click here to learn requirements.

Please fill out all information to the best of your knowledge.

Email *

Legal First Name *

Legal Last Name *

Nickname

Gender *

Street Address *

City *

State- Please spell out full name. *

Zip Code *

Mobile Phone Number *

Birthdate *

YYYY

T Shirt Size *

Adult Small

Adult Medium

Adult Large

Adult XL

Adult 2XL

Adult 3XL

Adult 4XL

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 dys4kids.org/camp-staff/ to fill out the correct application for you

Lead Counselor (requires at least 3 years' experience at Hot Shots Camp)

Regular Counselor

Lead Counselor- Volunteer (requires at least 3 years' experience at Hot Shots Camp)

Regular Counselor- Volunteer

Nutritional Information

Please fill out to the best of your ability.

Do you have Celiac disease/gluten intolerance? *

Yes

Do you have any allergies? *

Yes

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. *

Availability

Please answer to the best of your ability.

Which camps are you able to participate in? Select all that apply. *

Little Shots Day Camp- Ohio: July 8-11, 2024 At Olander Park, Sylvania OH (ages 5-10)

Little Shots Day Camp- Michigan: July 22-25, 2024 at ProMedica Farms in Tecumseh, MI (ages 5-10)

Middle Shots Resident Camp in Ashley, OH- June 17-20, 2024 (ages 10-13)

Big Shots Resident Camp in Ashley, OH- June 20-24, 2024 (ages 13-17)

Required

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.

Younger campers

Older campers

No strong preference

Have you been a counselor at Hot Shots camp in the past? *

No, this is my first year

Yes, 1-2 years

Yes, 3+ years

Required

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? *

Yes

Required

Please indicate your current vaccine status. *

Not vaccinated

Have received initial vaccine(s) but have not received booster vaccine

Fully vaccinated- have received initial vaccine plus booster

Required

Have you even been convicted of a felony? *

Yes

Required

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. I authorize Diabetes Youth Services to preform a criminal background check on me to investigate my background. These actions may result in a report on my character, reputation, personal characteristics, and criminal history and wil involve searching any state sex offender database for my name.

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
Director, Program Development
419-291-1238
cindy@dys4kids.org

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, 2024. 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.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms