Junior Counselor Application

Junior Counselor Name*
First Last
Birth Date*
MM slash DD slash YYYY
Grade Entering Fall 2021*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email (if you have one)
Phone (if you have one)
Parent Name
Provide contact information for one parent.
First Last
Parent Email
Parent Phone
Which week are you applying for?*
- June 14-18
- June 21-25
Why do you want to be a junior counselor?*
What kind of experience do you have with helping younger children?*
What experience do you have with the arts (visual, performing, music, and culinary arts)?
Reference Name
Provide a reference who is not a family member.
First Last
Reference Phone
Reference Email
Agreements*
Check the boxes indicating that you agree with the following:
- I agree to be helpful, respectful, and kind to all campers and staff.
- I agree to be an active assistant in the class to which I am assigned.
- I agree to leave all electronics at home or with parents during camp hours.
Electronic Signature*
I certify that by typing my name below in the Electronic Signature Field and submitting this form, I intend to sign this document and be bound to the same extent as if I had provided a physical signature.