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Volunteer Assistant Counselor Application - 2021
Personal Information
Name
*
First
Last
Gender
*
Please Choose
Male
Female
Email
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent/Guardian Home Phone
*
Parent/Guardian Cell/Work Phone
*
Home Congregation
*
Pastor
*
Congregation Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Camp Experience
How many years have you been a camper at Camp Shalom?
*
Have you been an Assistant Counselor before?
*
Please Choose
Yes
No
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
*
Session A: June 13 - 18, June 20 - 25
Session B: June 27 - July 2, July 18 - 23
Session C: July 25 - 30, Aug 1 - Aug 4
Second Choice
*
Session A: June 13 - 18, June 20 - 25
Session B: June 27 - July 2, July 18 - 23
Session C: July 25 - 30, Aug 1 - Aug 4
Third Choice
*
Session A: June 13 - 18, June 20 - 25
Session B: June 27 - July 2, July 18 - 23
Session C: July 25 - 30, Aug 1 - Aug 4
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