2019 Panthers Camp - Staff Application (Counselor & Instructor Positions)
This is a job application for a staff position with Panthers Camp, summer 2019. To apply, please answer the following questions and submit the following online form.

All applications are due by 2/20/19.

The first year Counselor (C1) must be entering 11th grade. The second year Counselor (C2) must be entering 12th Grade. The third year Counselor (C3) must be entering college. The Instructor will be in his/her fourth year +, must be in college or beyond.

Please contact Dan Flahavan if you have any questions - pantherscamppv@gmail.com

Applicants Last Name *
Your answer
Applicants First Name *
Your answer
Applicants Cell Phone # *
Please include area code. Insert N/A if not applicable.
Your answer
Applicants Email *
Your answer
Applicants Birthday *
MM/DD/YY
Your answer
Applicants Age *
During Camp
Your answer
Applicants Social Security # *
Your answer
Grade *
Entering in August 2019
Polition Applying for *
Weeks Available to work *
Required
Weeks you PREFER to work *
Required
Work Hours: 8:10 - 3:10 *
Please mention any issues you may have with working these hours (eg. need to leave early, etc.)
Your answer
Extended care is offered from 3:00-5:30. *
Are you available to work?
Shirt Size *
Address *
Street, City, ZIP
Your answer
Parent/Guardian Information
Parent/Guardian 1 *
First and Last Name
Your answer
Cell Phone *
Please include area code. Insert N/A if not applicable.
Your answer
Home Phone *
Please include area code. Insert N/A if not applicable.
Your answer
Work Phone
Please include area code. Insert N/A if not applicable.
Your answer
Email address *
Your answer
Parent/Guardian 2
First and Last Name
Your answer
Cell Phone
Please include area code. Insert N/A if not applicable.
Your answer
Home Phone
Please include area code. Insert N/A if not applicable.
Your answer
Work Phone
Please include area code. Insert N/A if not applicable.
Your answer
Email address
Your answer
Emergency & Health Information
Emergency Name *
First and Last Name
Your answer
Emergency Contact Phone *
Please include area code.
Your answer
Health Insurance Carrier *
Your answer
Group/ID Policy # *
Your answer
Waiver
The following Waiver (District Release, Hold Harmless, Medical Release, Photo Consent) is required for Participation in Panthers Camp. Without exception, failure to sign this permission slip will preclude participation in Panthers Camp.

DISTRICT RELEASE: With my signature below, I acknowledge that the Panthers Camp (Camp) is neither sponsored nor endorsed by the Portola Valley Elementary School District (District) and I hereby release the District from any potential liability emanating from the programmatic operation of this Camp.

HOLD HARMLESS: I, the undersigned, parent or guardian, do hereby agree to allow the individual(s) named herein to participate in Panthers Camp and I further agree to indemnify and hold harmless Dan Flahavan and the Panthers Camp Staff from and against any and all liability for any injury which may be suffered by the aforementioned individuals arising out of or in any way connected with participation in this camp program.

MEDICAL RELEASE: In the case of a medical emergency, I give permission to Dan Flahavan and the Panthers Camp Staff to order treatment for my child. This includes any medical treatment or x-rays.

PHOTO CONSENT: I give consent for photos/videos of me/my child to be used in promotional materials, camp publications, & website postings. I understand campers will not be identified by name on any promotional materials or photos unless additional permission has been granted by the parent/guardian.

Applicant Electronic Signature *
Selecting "Yes" will serve as my authorization and signature.
Required
Parent Electronic Signature
If under 18 years old, you need a parent signature. Selecting "Yes" will serve as my authorization and signature.
Signature Date *
Your answer
Thank you for applying for a staff position at Panthers Camp.
All applications are due by 2/20/19.

All applications will be processed and notices of hire will be sent out by April 15th or sooner.

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