Become a Counselor

Counselor Form

Name

Phone Number

Street Address

Address Line 2

City

State

Zip/Postal Code

Country / Region

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Age

Grade

School

Why do you want to be a counselor?

Have you ever worked with special needs children and if so where?

Any other factors skills/talents that you can contribute to the camp?

T-Shirt Size

Reference 1

Reference 1 Contact Number

Reference 2

Reference 2 Contact Number

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Emergency Contact

Name

Phone Number

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