First Name: *

Last Name: *

Contact Number: (Cell number please) *

Home Address: *

Birth date: *

Gender: *

Highest grade completed *

School: *

GPA: (Most recent) *

Previous work experience: (most recent listed first) *

Why are you interested in TheEdgeCamp Counselor Position? *

What is your experience working with school age children? *

Other experience applicable to working at summer camp? *

Special Interests (leisure, academic, career...) *

Please provide your AVAILABLE weeks to work. *

I am able to work from 9 am to 4 pm. *

I am able to work during PM Extended Care, 4-6pm *

Want camp lunch? (Provided) *

T-shirt Size: (Provided) *

Sweatshirt Size: (Provided) *

Emergency Contact Name: *

Family Doctor Number: *

Health Plan: *

Policy Number: *

Health History: *

Please give details on any health issues checked above: *

Any activity restrictions: *

If yes, give details *

Photo Release *

I acknowledge that the above information is accurate to the best of my ability. *