Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Cell Phone *

(###)

###

####

Name of Emergency Relative *

First Name

Last Name

Cell Phone *

(###)

###

####

Which Week(s) are you Available *

Week 1 (June 2-6)

Week 2 (June 9-13)

Have you worked our camp before? *

Yes

No

Have you worked at any other camps? *

Yes

No

Reference 1 *

First Name

Last Name

Reference 1 Phone Number *

(###)

###

####

Reference 2 *

First Name

Last Name

Reference 2 Phone Number *

(###)

###

####

Have you received any certifications *

No

CPR

Babysitting

Lifeguard

Other

Terms and Conditions *

1. If I am hired to work as a Counselor, I will be expected to work the entire week, Monday-Friday. 2. To complete the application process, I must attend a Youth Protection Meeting prior to camp. If I am 18 years old or over, I must also complete the Archdiocese Youth Protection Program and background check. 3. By completing this application, I am not guaranteed a position.

By Checking this box I understand the above stated items and will abide by them.

Signature *

I understand that checking this box and providing my name below constitutes a legal signature.