First Name:

*

Last Name:

*

Middle Inital:

Gender:

Female

Male

Your E-mail Address:

*

How did you hear about the camp?

*

What position are you applying for?

General

Specialist (Please specify)

Group Counselor

Sports Activity Leader (Please specify)

Art/Music/ Dance/ Theater Activity Leader (Please Specify)

Lifeguard/Swim Instructor

Social Security #:

Date of Birth:

*

Age :

Permanent Address:

*

City:

*

State:

*

Zip:

*

Summer Address:
(If Different from Permanent Address)

City:

State:

Zip:

Have you ever been convicted of a criminal offense?

Yes......Please explain:*

No

Home Phone#:

Cell Phone#:

Are you a U.S. citizen?

Yes

No

School Name

Graduation Date

Major

High School

College

Grad School

Name

Position/Title

Address

Phone Number

Company

Position

Supervisor

Dates Employed

Phone Number

Reason for Leaving

0 1 2
Animals

0 1 2
Archery

0 1 2
Art

0 1 2
Basketball

0 1 2
Boating

0 1 2
Ceramics

0 1 2
Computers

0 1 2
Cooking

0 1 2
Dance

0 1 2
Drama

0 1 2
Fencing

0 1 2
Football

0 1 2
Gardening

0 1 2
Go-Carts

0 1 2
Gymnastics

0 1 2
Hiking

0 1 2
Hockey

0 1 2
Horses

0 1 2
Jewelry

0 1 2
Juggling

0 1 2
Karate

0 1 2
Lacrosse

0 1 2
Magic

0 1 2
Music

0 1 2
Nature

0 1 2
Newspaper Staff

0 1 2
Orienteering

0 1 2
Outdoor Cooking

0 1 2
Photography

0 1 2
Puppetry

0 1 2
Rocketry

0 1 2
Ropes Course

0 1 2
Science

0 1 2
Soccer

0 1 2
Softball

0 1 2
Swimming

0 1 2
Tennis

0 1 2
Video

0 1 2
Volleyball

0 1 2
Wood Working

Other (Name):

Gate Hill Day Camp is not easily accessible
by public transportation. Do you require transportation?

Yes

No

Would you be interested in driving campers to camp?

Yes

No

Would you be interested in being a bus counselor?

Yes

No

NOTE: All applicants must be prepared to be a bus counselor if needed.

Do you possess a valid driver's license?

Yes

No

If so, how many years?

Driver's license #:

The 2 streets that border your home are:

and:

The nearest main road is:

Title

Date