AC Application Form

Personal Information

Name*

First Last

Gender*

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Birth Date*

MM

DD

YYYY

High School (name and city)*

School - Grade Completing*

Parent/Guardian Name*

First Last

Parent/Guardian Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian Home Phone*

Parent/Guardian Cell/Work Phone*

Home Congregation*

Pastor*

Congregation Address*

Street Address Address Line 2 City State ZIP Code

Camp Experience

How many years have you been a camper at Camp Shalom?*

Have you been an Assistant Counselor before?*

How many years?*

References

Please list 2 adults (not related to you) that know your character & work abilities. Have them complete a Reference Form, and mail it in to the Camp Office, Attn: Ben Carlson

Name*

First Last

Phone*

Relation to You*

Name*

First Last

Phone*

Relation to You*

Personal Statements

How is Christ important in your daily life? How do you live out your faith?*

Why would you like to work at Camp Shalom as an Assistant Counselor?*

What can you contribute to our camping community?*

Week Assignment Preferences

(Rank 1-3; 1 being most desirable) Note that assignments will be made on a need basis, so limits of only one 2-week session may occur. AC’s have the weekend off in between their 2 weeks of volunteering.

First Choice*

Second Choice*

Third Choice*

Volunteer Assistant Counselor Application - 2021

Personal Information

Camp Experience

References

Personal Statements

Week Assignment Preferences

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