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Junior Counselor Application

  • MM slash DD slash YYYY
  • Provide contact information for one parent.
  • Provide a reference who is not a family member.
  • Check the boxes indicating that you agree with the following:
  • 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.