2018 Counselor / Staff Application
If at any time you have questions regarding this form, please contact Jereme Miner, Camp Director at:
apply@clarksvillecamprainbow.org or 931-320-3473.
Email address *
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Age *
Your answer
Gender *
Required
Birth Date *
MM
/
DD
/
YYYY
Home Address
Street: *
Your answer
City: *
Your answer
State: *
Your answer
Zip: *
Your answer
Employer
Employer Name: *
Your answer
Work Phone: *
Your answer
Your Contact Info:
Home Phone:
Your answer
Work Phone:
Your answer
Cell Phone: *
Your answer
Email Address: *
Your answer
Emergency Contact
Name: *
Your answer
Home Phone:
Your answer
Work Phone:
Your answer
Cell Phone: *
Your answer
Email Address: *
Your answer
If 2018 will be your first year as a counselor or staff member, please complete the following question:
For background check only, please enter your Social Security Number: *
Your answer
General Questions
Have you been a Camp Rainbow counselor before? If yes, how many years?
Your answer
Have you been a Camp Rainbow staff member before? If yes, how many years?
Your answer
Do you have a personal reference in Camp Rainbow or where you work that we could contact? If you know someone at Camp PLEASE list: If no, type NA *
Your answer
What talents or interests do you have that will help us at Camp? (Please check as many as you want. For items requiring lists and/or explanations please use the textbox below.)
For items requiring lists and/or explanations please use this textbox.
Your answer
Do you have any physical disability that would prevent you from lifting a wheelchair-bound child: *
Required
Do you have a camper age preference? If yes, please list.
Your answer
Can you be available from noon June 10th - noon June 16th? *
Required
Do you have a request for a specific Camp duty? If yes, please explain. *
Your answer
Do you have a request to be assigned to a specific camper? If yes, who?
Your answer
Do you have any comments or suggestions for Camp? *
Your answer
Please tell us why you want to be involved with Camp Rainbow *
Your answer
Does Camp Rainbow have permission to use your name and picture for publicity or public service announcements on televisions, newspaper, radio, and other media? *
Required
THE SIZE YOU PICK IS THE SIZE YOU GET!!
What is your shirt size? *
Required
Sweatshirt Size? *
Required
All information provided above is correct and I understand that I may be subject to a personal background check.
Terms and conditions: by checking the box thereby agreeing, I certify that I am the person identified in this application and that all information provided herein is true and correct. I further acknowledge that I have read and understand this application and all attachments. I understand that incomplete or false answers may be grounds for ineligibility or termination. I understand that an electronic signature has the same legal effect and enforceablility as a written signature on an application.
Do you agree to the terms and conditions? *
Required
Please type your name: *
Your answer
Date: *
Your answer
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