CAMP GAN ISRAEL

Junior Counselors must be entering 9th, 10th, 11th or 12th grade              

Junior Counselor Information
First Name

Last Name
Full Jewish Name
Mother's Jewish Name
Age
Date of Birth
Born after Sunset
Yes No		 Hebrew Birth Date (if known)
Home Address
City
State
Zip
Home phone
Your Email 
Your cell phone
 Mother's Email  Father's Email 
Mother's Work phone 
 Mother's Cell phone 
 Father's Work phone 
Father's Cell phone 
    
Current School & Grade Entering  Previous school Attended (which grades)  Previous school Attended (which grades)
 
Preferred Age Group
What age group between the ages of 3-9 would you prefer to work with?
Choice 1
Choice 2 Choice 3
Experience
Have you worked with children before? Yes No
List 3 references of people for whom you've worked within the past 2 years. It could be in the capacity of babysitting, assisting, or teaching in a synagogue, camp or any other setting with children.
Company Name
Position, Dates & Briefly describe your responsibilities
 Name of Reference & Contact Number
Company Name
Position, Dates & Briefly describe your responsibilities
 Name of Reference & Contact Number
Company Name
Position, Dates & Briefly describe your responsibilities
 Name of Reference & Contact Number


Emergency Contact Information
Contact 1
Phone
Relationship to Applicant
Are there any medical concerns, allergies or dietary requirements that we should be aware of?
Contact 2
Phone
Relationship to Applicant
Parent's Daytime Phone
Parent's Daytime Phone
Parent's Daytime Phone
Family Physician
Phone
Address

Available Days
Camp runs from 9am – 4pm (3pm Fridays), from June 28-August 1, 2018. Even if you are a junior counselor in the Mini Gan division you will either be assisting at the Aftercare Program, assist the head counselor, or participate in workshops arranged especially for Junior Counselors and CITs until 4 pm.

I understand that Camp runs from June 28th to August 1st, 2018, and that I need to be available for pre-camp training all day, in the 2 days prior to camp (June 26th and 27th) and registration to be a Junior Counselor is for the full session. 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.


Tee Shirts
Please select your t-shirt size. You will be given 2 camp T-shirts and are required to wear one to camp every day. T-shirts can shrink and tend to run small. When in doubt, order the next size. (Sample shirts are available to try on for sizing.)
SIZE: Small Medium Large Extra Large
SLEEVE LENGTH: Short Sleeves Long Sleeves
I agree to follow the camp staff dress code: camp t-shirt (can be short or long sleeved). For girls: knee length skirt (no mini-skirts), socks. For boys: long pants, kipa, tzitzit, and socks.
I can expect to receive an email acknowledging receipt of this application and a second email indicating acceptance (or otherwise) within 2 weeks of today's date.
Signature  Date


Parental Permission
I hereby give permission for my child to volunteer in camp on the aforementioned dates.
Parent/Guardian Date