Complete the application below and someone will get back to you. All fields are required unless otherwise stated. Name Age Date of Birth Address City State Zip Email T-Shirt Size—Please choose an option—Youth SYouth MYouth LAdult SAdult MAdult LAdult XL Applying ForWhole SummerFirst HalfSecond Half Position DesiredCounselorJunior CounselorLifeguardLearning RebbeJunior AssistantArts & Crafts/Woodworking Which age group do you prefer?Grades 1-2Grades 3-5Grades 6-9 Phone Numbers Home Best Time to reach Cell Best Time to reach Yeshiva Best Time to reach YESHIVAHS ATTENDED Now Grade Last Year Grade Two Years Ago Grade Rebbi Phone Menahel Phone CAMP EXPERIENCE (if any) Name of Camp Position Year Attended Reference Phone Name of Camp Position Year Attended Reference Phone Your Skills Please check any of the following attributes that you could share with us as a staff member at Camp Merockdim: BaseballTeach SongsSwimmingArts & CraftsWrite playsOvernight hikingWoodworkingAct in playsFunBasketballVolleyballMusical instrumentOther If Other References Reference 1 Relationship to you Phone Reference 2 Relationship to you Phone Δ