Confidential Reference Questionnaire

Please give careful consideration to the ratings below. Please call (770) 460-9451, email camp@covenantpres.net, or check out our web page at www.campcovenant.net if you have any questions. Thank you very much for your cooperation.
Name of Applicant *
Your answer
Objective Rating
Please check the adjective that most accurately describes the applicant's habitual behavior.
Leadership *
Cooperation with Others *
Attitude *
Flexibility *
Responsibility *
Punctuality *
Emotional Maturity *
Spiritual Maturity *
Do you think this individual would make a good camp counselor? Why or why not? *
Your answer
Would you be willing to have your child under his/her supervision in a camp situation? Why or why not? *
Your answer
Is this individual dependable? Can he/she be relied upon? *
Your answer
Does this individual weaken in the absence of authority? *
Your answer
How does this individual react in situation of stress, i.e., make decisions? *
Your answer
How long have you known the applicant? *
Your answer
What is your relationship to him/her? *
Your answer
Have you seen him/her in a leadership role with children or teens? If so, what was the position? *
Your answer
Thank you very much for your time! We may be in contact with you concerning the applicant.
Printed Name *
Your answer
Occupation *
Your answer
Phone Number *
Your answer
Email *
Your answer
Signature *
Your answer
Date *
Your answer
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