Staff Application

Name

Age

Date of Birth

Address

City

State

Zip

Email

Phone

T-Shirt Size—Please choose an option—Youth SYouth MYouth LAdult SAdult MAdult LAdult XL

Cell

Prefer Text Messages?YesNo

School Attending

Grade Attending

Camp's attended as camper

Please select position you are applying forCounselorJunior CounselorLifeguardMothers helperSpecialty Assistant

Applying ForWhole SummerFirst HalfSecond Half

Which age group do you prefer?Grades 1-2Grades 3-5Grades 6-9

Do you have any past experience? If yes, please list where, your job and how long you worked there:

Please check any of the following attributes that you could share with us as a staff member at Camp Merockdim:
SingingDancingActingArtisticSportsOther

If Other

List two references (not family members), their phone numbers and relationship to you