CAMP GAN ISRAEL 2018

Counselor Information
Last Name
First Name
Full 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
Current grade
Completed Seminary 1?
Name of Seminary currently/will be attending next year?
 
 
Certification
Are you First Aid certified?
Yes No
If yes, when does it expire? If yes, please submit a copy of your certification form via email to  Camp@ChabadRiverdale.org.
Are you CPR certified?
Yes No
If yes, when does it expire? If yes, please submit a copy of your certification form via email to Camp@ChabadRiverdale.org.
Are you generally healthy? Please list any specific allergies, medical issues, dietary kashrus requirements that we should know about.
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
List 3 adults for whom you've worked within the past 2 years in a summer camp, Hebrew school or Junior Congregation. List your position and a contact phone number as reference.
Camp, School or Synagogue Name
Position
Name of Reference & Contact Number
Camp, School or Synagogue Name
Position
Name of Reference & Contact Number
Camp, School or Synagogue 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
Contact 2
Phone
Relationship to Applicant
Parent's Daytime Phone
Parent's Daytime Phone
Parent's Daytime Phone
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 –4pm (3pm Fridays), from June 28 to August 1, 2018.
I understand that camp runs from June 28-August 1, 2018, 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, write the date(s) when you need to be absent: . Please understand that this will be taken into consideration when choosing staff.

I will arrive and be fully available for pre-camp training up to three days before camp begins and will remain until the day after camp ends, after noon.   That means I will arrive on June 25 and will depart on August 2.

 
As every one of our staff members is a Shlucha and represents the Rebbe in everything she does, staff dress code  must be one that befits such status.  Standards of Tznius for our staff include but are not limited to: A) long length skirts that cover the knees at all times with no slits at all. B) leg coverings no shorter than knee socks. C) sleeves that cover the elbows at all times. D) necklines that cover “the bone” at all times D) long sleeve camp t-shirt in camp every day.   This is very important to us and not “negotiable”.  These standards apply throughout the duration of a counselor’s stay in Riverdale, NOT only during camp hours.
I   understand that by signing this form I have applied in earnest to be a staff member at Camp Gan Israel of Riverdale, and I can expect to hear a response from the camp director within 2 weeks from the application date.  From the time I sign this application form I will not be available to be hired for the same dates elsewhere.   By signing this form I am indicating that I am ready to be a staff member at CGI Riverdale if I am accepted.
Counselor's Signature   Date

Parent/Guardian (if under 18 years of age)   

Date