Camp Counselor Form : Parkview Services

Camp Parkview Camp Counselor Application

Sunday August 11th - Friday August 16th, 2013 (Camp begins the 11th, new counselors are required to be on-site by 5:30 PM August 10th for dinner and orientation.)

What is an on-site counselor?
An on-site counselor remains on-site throughout the entire session, shares sleeping quarters with campers, and fully participates in the camp activities.

What is a day counselor?
A day counselor is at camp during specific times of the day, or for a limited part of the camp session. They will primarily act as support and relief for the on-site counselors, filling in so they can take breaks or when activities require a higher counselor-to-camper ratio.

* All fields are required except as noted. All applicants must pass a Washington State Criminal Background Check.
I am applying for:*
On-site Counselor
Day Counselor
Tentatively, what days and times will you be available?:
Have you volunteered as a camp counselor in the past?*
No
Yes (I ve volunteered less than 3 years)
Yes (I've volunteered 3 or more years)
Name
FirstLast
Address:*
Street AddressCityState / Province / RegionZip / Postal Code
Date of Birth:*
Phone:*
Day Telephone:*
Evening Telephone:*
Email:*
Emergency Contact Full Name:*
Emergency Contact Telephone:*
Education:
Applicants Current Occupation:

What has been your previous camp experience? (Previous experience is not necessary. All staff will receive training before camp starts) (Returning counselors, feel free to be brief, but we really appreciate your information). *
What experience have you had with persons with developmental disabilities? *
What has been your previous experience as a counselor, teacher, or program leader? *
I have the following skills to offer as a camp counselor: *

References
Please give names of three persons whom you have known for at least one year, not including relatives. (If you have been a counselor at Camp Parkview in the past three years, you do not have to give references).
1. Name*
FirstLast
Relationship to You*
Number of Years Known*
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Daytime Phone Number:*
Evening Phone Number:*

2. Name*
FirstLast
Relationship to You*
Number of Years Known*
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Daytime Phone Number:*
Evening Phone Number:*
Email

3. Name*
FirstLast
Relationship to You*
Number of Years Known*
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Daytime Phone Number:*
Evening Phone Number:*
Email
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Do You Have any Special Diatary needs?*
Yes
No
Please specify your dietary need:*
Do you plan to attend the counselor dinner and orientation on Saturday August 10th?*
Yes
No
Do You Need a Stipend in Order to Participate at Camp Parkview?*
Yes
No
Do You Need a Car/Driver or Passenger Ticket?*
Car/Driver
Passenger
What is Your T-shirt Size?*
Small
Medium
Large
XLarge
XXLarge

Parkview Services does not discriminate on the basis of sex, sexual orientation, age, race, ethnic origin, color, religion, national origin, creed, marital status, disabled veteran status, or the presence of any sensory, mental, and/or physical disability that doesn't prevent the performance of the specific core tasks of this position.
I authorize Camp Parkview to complete a Washington State Patrol criminal history background check. I understand that the results of this background check will be kept confidential.

Parkview Services

Camp Parkview Camp Counselor Application

Step 1 of 3

References

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