Name *

First Name

Last Name

Phone *

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which program are you interested in being a counselor for? *

Select all that apply.

Summer Camp, July 8-12 (You must be between the ages of 13-25)

Summer Camp, July 15-19 (You must be between the ages of 13-25)

Are you a new or returning applicant? *

New (If you are a new applicant, please complete the questions below.)

Returning (If you are a returning applicant, you do not need to complete the questions below.)