Counselor Application Form

All prospective counselors must fill out this form for each week or weekend camp event.

NOTE: Social Security Number is REQUIRED only for those 18 years of age or older.  If you are younger than 18, enter "n/a".  

Counselor Information
Name *
Name
This is needed for all counselors 18 years of age or older in order to run background checks. Should fit the format of 123-45-6789.
Gender *
Home Phone *
Home Phone
Cell Phone
Cell Phone
Address *
Address
Date of Birth *
Date of Birth
Experience & Interests
Please list any experience with camping, counseling, and/or working with developmental disabilities.
Please list any special talents or interests you would like to contribute to New Day.
Parent or Guardian Information
If under 18, please fill out.
Guardian Home Phone
Guardian Home Phone
Guardian Cell Phone
Guardian Cell Phone
Guardian Work Phone
Guardian Work Phone
Emergency Contact Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Home Phone *
Emergency Contact Home Phone
Emergency Contact Work Phone
Emergency Contact Work Phone
Emergency Contact Cell Phone
Emergency Contact Cell Phone
Emergency Contact Address *
Emergency Contact Address
Medical Information
Doctors Name *
Doctors Name
Doctors Phone *
Doctors Phone
Doctors Address *
Doctors Address
Please list any medical conditions.
Please list any allergies.
Please list any medications and dosage of each (please note that ALL medications must be clearly labeled and stored with the nurse upon arrival, REGARDLESS OF AGE).