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Teacher Application Form

Teacher Application Form

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 CAMP GAN ISRAEL 2017

Counselor Information
Last Name
First Name
Hebrew Name
Mother's Hebrew Name
Age
Date of Birth
 
Born after Sunset
Yes No
Hebrew Birth Date
 Home Address
 City
 State
Zip
Home phone
Cell phone
Email
Social Security
Citizenship
USA Other - 
 Specify
Completed 12th Grade
Completed Seminary 1
Name of Seminary attending/attended
 
 
Certification
Are you First Aid certified?
Yes No
If yes, when does it expire? (If yes, Send the form by email to Camp@ChabadRiverdale.org)
Are you CPR certified?
Yes No
If yes, when does it expire? (If yes, Send the form by email to Camp@ChabadRiverdale.org)  
Please list any specific allergies: 
Do you have a driver’s license?
Yes No 
If yes, how many years have you been driving?
Do you feel comfortable with having the responsibility of driving the counselors? Yes No 
Driving a mini-van? Yes No 
Do you have experience and feel comfortable driving on highways? Yes No 
      
Preferred Age Group
Please choose and number according to preference:
Which ages do you prefer working with?
5 year olds 6 year olds 7 year olds 8 year olds 9 year olds
Experience
Have you worked with children before? Yes No
Describe any previous experience of supervising/working with children:
Company Name
Position
Name of Reference & Contact Number
Company Name
Position
Name of Reference & Contact Number
Company Name
Position
Name of Reference & Contact Number

References
Personal
Reference Name
Relationship to Applicant
Phone
Reference Name
Relationship to Applicant
Phone


Emergency Contact Information
Contact 1
Phone
Relationship to Applicant
Are there any medical concerns that we should be aware of?
Contact 2
Phone
Relationship to Applicant
Parent's Daytime Phone
Parent's Daytime Phone
Parent's Daytime Phone
Please list any specific dietary kashrus requirements: shechita, milchig, etc…
Family Physician
Phone
Address

Talents
Please choose and number according to preference:
Mark areas in which you are talented:

Organization

Responsibility

Camp Spirit

Creativity

Sports

Drama

Computers

Art

Choir

Dance

Music
 
Do you play an instrument? Yes No  If yes which one?
Would you like to be the coordinator of extra-curricular activities for the staff? Yes No


Tee Shirts
You will be required to wear a camp T-shirt every camp day. Please select your t-shirt size. T-shirts can shrink and tend to run small. When in doubt, order the next size.
SIZE:  Small Medium Large Extra Large


Signature
Camp runs from 9am –3:55pm (2:55pm Fridays), from June 30th to August 2nd, 2016.
I understand that Camp runs from June 30-August 2, 2016, and registration to be a counselor is for the full session only. If there are extenuating circumstances that prevent you from attending camp for the entire session, please include here the date that you will be leaving camp . Please understand that these dates must be approved by the camp director.

In addition, I will be available for pre-camp training up to three days before camp begins.

I agree to adhere to the camp dress code: All staff is required to wear the Camp T-shirt every day. Lubavitch female staff are required to wear a long sleeved camp t-shirt, long skirt, and knee socks (leggings are not permitted) at camp. If a staff member is told is told to discontinue wearing a certain article of clothing in camp because it is deemed inappropriate, s/he is required to comply. Staff is required to walk to the pool completely clothed. Please remember that our camp represents Torah true Judaism and every staff member who works for our camp agrees to present his/her self as a representative for the ideal that our camp stands for.
I understand that Camp Gan Israel of Riverdale, has accepted me as a member of their staff and they will not replace me with someone else nor renege on their commitment. Similarly, once I have verbally committed to being a counselor at Camp Gan Israel of Riverdale, I will not be available to be hired elsewhere, nor will I renege on my commitment.
 
Counselor's Signature   Date
Parent/Guardian    Date

 

 

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