Name:
Bird Name (if you have one):
Home phone Number:
Cell phone Number:
Email address:
Are you at least 18 years old?
Yes
No
Home Address: (Just type with spaces)
School Address (if applicable):
Sex:
Male
Female
Check which week(s) you are applying for:
Week 1 (July 18-24)
Week 2 (July 25-31)
Week 3 (August 1-7)
Week 4 (August 8-14)
Education:
Highest Grade:
High School grade 9
High School grade 10
High School grade 11
High School grade 12
College 1 Year
College 2 Years
College 3 Years
College 4 Years
Graduate Degree?
Yes
No
College Attended:
Major Fields/Degrees:
Current Employment: Firm:
Name of Supervisor:
Supervisor's Phone Number:
Supervisor's Email Address:
References: List three references (not relatives) who have observed you in leadership positions and working with children.
One reference should be someone from your church.
1) Name
Position
Phone
Email:
2) Name
Position
Phone
Email:
3) Name
Position
Phone
Email:
First Age Group Preference (Select One):
Pilgrims (grades 3-4)
Settlers (grades 5-6)
Colonists (grades 7-9)
Explorers (grades 10-12)
Special Teams
Second Age Group Preference (Select One):
Pilgrims (grades 3-4)
Settlers (grades 5-6)
Colonists (grades 7-9)
Explorers (grades 10-12)
Special Teams
Check position(s) you would like to serve:
Cabin Counselor
Division Director
Horsemanship Specialist
Cook
Activity Coordinator
Special Team Coordinator
Business Manager
Life Guard
WSI
Tuck Shop Manager
Admin. Assistant
Grandma/Grandpa Birds
Nurse
Special Teams (Support)
Service Crew (Kitchen)
Service Crew Building/Grounds
Activity Specialist
Area:
Check if you are UNwilling to serve in a co-counselor position
Co-counselor preference
Leadership Experience:
Previous Camping Experience: Camper At: (Name of camp)
Age: (when attended)
Number of Years
Camp Staff Member At:
Number of Years
Postition(s) held:
Other experience working with children
Other leadership experience (church/community):
Church you attend:
City/State:
Describe your conversion and Christian experience
How would you explain the steps to becoming a Christian? (include Scripture references)
Why do you want to work at Cedarbrook Camp of Ohio this summer?
How did you hear about Cedarbrook Camp of Ohio?
Voluntary Disclosure Statements:
Do you have any physical or mental limitations that would limit your participation in camp activities?
No
Yes
If yes, please explain
Do you have any contagious or communicable diseases that may endanger others?
No
Yes
If yes, please explain
Have you ever been convicted of a crime?
No
Yes
If yes, please explain
Are there any felony charges pending against you?
No
Yes
If yes, please explain
Mandatory annual fingerprinting and criminal background check (required by The American Camp Association and State of Ohio): Check our website www.cedarbrookcampoh.com for further instructions.
I attest that everything in this application is true.
No
Yes Signature