COUNSELOR APPLICATION
Camp ENERGY Volunteer Counselor Application for the week of August 5 - 11, 2017
BASIC INFORMATION
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Permanent Address (Street) *
Your answer
Permanent Address (City) *
Your answer
Permanent Address (State) *
Your answer
Permanent Address (Zip) *
Your answer
If you have a temporary address (for example, a college dorm), please list here:
Your answer
Phone number *
Your answer
Sex *
Age (at time of camp in August 2017) *
Your answer
T-Shirt Size *
EMERGENCY CONTACT
Emergency Contact Name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
QUESTIONS
To protect the health of our campers, we require that all counselors are up to date with their vaccines as recommended by the Center for Disease Control (CDC). https://goo.gl/2HyVqH Have you complied with these recommendations? *
Do you have any experience working with adolescents? If so, in what capacity?
Your answer
How did you hear about Camp ENERGY?
Your answer
Do you work at Geisinger Health System? *
Are you a healthcare provider? *
Do you have any special interests you can offer at camp? (i.e. physical activity instructor, team-building games, cooking demos, etc.)
Your answer
Is there anything else we should know?
Your answer
REFERENCES
References are required for new applicants; returning staff do not need to complete
Reference #1
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Reference #2
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Reference #3
Name
Your answer
Phone Number
Your answer
Email Address
Your answer
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