Campus Day Camp Staff Application

2901 Campus Rd. Brooklyn, N.Y. 11210 718.421.7575

Date

Full Name *

Position *

Date of Birth *

Address *

Address

City

State/Province

Zip/Postal

Phone *

Email

Known Allergies / Medical Conditions

Emergency Contact *

Relationship *

Emergency Phone Number *

Name *

I

hereby authorize Campus ASP Inc. to take any emergency medical actions necessary.

Signature *

Clear

Date

Briefly describe why you want to work in summer camp. *

Describe why a camper would want YOU as his/her camp counselor this summer. *

Please list any skills, interests or hobbies. *

Do you have any other commitments (school, vacation, other job) between 6/29/23 - 8/11/23? *

Yes

No

Will you be able to have a medical form completed by a physician before May 15, 2023? *

Yes

No

Are you both mentally and physically fit to perform the duties required (Sports, swimming, strenuous exercise, bending, extreme temperatures, standing for long periods of time etc.)? *

Yes

No

Attendance and punctuality are critical to a successful summer. Are you able to commit to the following: 6/29/23 - 8/11/23, 8:30am - 4:30pm? *

Yes

No

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