Arlene Streisand's
Summer Camp Services
P.O. Box 196
Jericho, NY 11753
1-800-443-6428 • • • 516-433-8033
Fax: 516-933-7949

PRINT THIS APPLICATION FIRST!
ANSWER ALL QUESTIONS and fax to: 516-933-7949

APPLICATION CHECKLIST

Please make sure you complete the following:

• Answer ALL questions on the application

• Attach a recent photo

• Enclose (if available) reference forms or letters of reference

• Include copies of credentials such as WSI, LGT, LGIT, Coaching Licenses, etc.

APPLICATION

Name:__________________________________Social Security #_____________________

Present Mailing Address:_____________________________Telephone:________________

City______________State_________Zip Code______________E-Mail________________

Permanent Address:_________________________________Telephone:________________

City______________State_________Zip Code______________E-Mail________________

Height:____________Weight:_______Date of Birth:___________Sex (M or F)___________

Age as of next July 1st:_____________

Are you available from approximately June 15 to August 18?__________________________

Salary request:_________________

Age group you prefer for your own cabin assignment:_________________________________

What type of position do you want at camp? If specialties, list in order of preference:_________

_________________________________________________________________________

Do you currently hold any American Red Cross instructor certificates? If so, please list expiration dates:____________________________________________________________________

WSI___________CPR___________EMT___________First Aid Responder_____________

Canoeing__________First Aid__________Certified Rescue Aide__________Other________

Sailing____________Life Guard_________Life Guard Instruction/Trainer________________

Any physical defects or diseases affecting your ability to perform your job:_________________

_________________________________________________________________________

If you have a friend or a relative interested in camp work, please state their name, address and

telephone number: Name:___________________________________________________

Address:___________________________________________Phone:________________

Do you own a car?____________Would you drive to camp?_________________________

Would you be willing to take passengers?________________________________________

PLEASE COMPLETE (attach additional sheets if necessary)
You MUST answer the questions below:

1) Outline your training and/or experience in the activity areas you wish to work. Include any other biographical data such as family, travels, camping experiences, etc., which might have a bearing in this application. Be sure to include any competitive or varsity experiences:

2) Why do you want to be a camp counselor? What contribution do you think you can make at camp? What qualities or characteristics do you feel you have which will enable you to be an effective counselor? Do you have any leadership skills or special abilities?

3) Please indicate first and second choice:

Circle Age Group of Campers you prefer for cabin duty: 5-7 • 7-9 •9-11 • 13-15 • 15 & over
• Flexible

Circle Age Group you are best equipped to teach: 5-7 • 7-9 • 9-11 • 13-15 • 15 & over
• Flexible

Please make a copy of your entire application and keep it for your records.

Signature:_____________________________Date:_____________________________

Important next step!!!!
CLICK HERE to get reference form!!!