CAMP GAN ISRAEL 2018

Mini-Gan Head 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 Seminary 1
Name of Seminary attending/attended
 
 
Certification
Are you First Aid certified?
Yes No		 If yes, when does it expire? If yes, please submit a copy of your certification form by 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 by email to Camp@ChabadRiverdale.org)  
Are you generally healthy?  Please list any specific allergies, medical issues or 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 
      
Experience
List 3 positions within the past 3 years in which you were in a preschool classroom. Include the date, for whom you worked and their contact information, name of the institution and a brief description of the job requirements.
Preschool Name & Dates 
 Position & Brief description of duties
 Name of Reference & Contact Number
Preschool Name & Dates
 Position & Brief description of duties
 Name of Reference & Contact Number
Preschool Name & Dates
 Position & Brief description of duties
 Name of Reference & Contact Number


Emergency Contact Information
Contact 1
Phone
Relationship to Applicant
Contact 2
Phone
Relationship to Applicant







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?


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 –2:30pm (3:00pm Fridays), from June 28 to August 1, 2018. The head counselor is required to stay until 4:00pm 1-2 weeks throughout the camp season for aftercare.
I understand that Camp runs from June 28-August 1, 2018, but that I need to also be available in the months leading up to camp to plan the program and be trained. I will need to be available for pre-camp training in Riverdale, in the 3 days prior to camp (June 25th-28th) and for 3 days after camp ends (August 2nd-4th) to pack and take inventory. Registration to be a Mini Gan Head Counselor includes all of the above mentioned dates. If there are extenuating circumstances that will prevent you from carrying out your responsibilities during this time, please write the date when you will need to be absent . Please understand that this will be taken into consideration when choosing staff.

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.
Mini Gan Head Counselor's Signature   
Date