NOTE: All counselor staff must be at least 19 years old during or before the summer.

College graduates should complete a Senior Staff application.

First Name:

Gender:

Last Name:

Social Secruity #:

- -

Email Address:

Date of Birth:

School Name:

Current Address

Street Address:

State:

City:

Zip:

Permanent Address

Street Address:

City:

State:

Phone:

Zip:

Cell Phone :

What is the best time to reach you?

Height: (inches)

Weight: (lbs)

How did you Hear about Lake Greeley Camp

Earliest Date Available

Latest Available Date

Do you Smoke:

Do you Swim:

Year in College:

College Major

Do you have any dietary restrictions?

if yes please Explain

Do you have any physical limitation that might limit your ability to watch over children at camp? If yes, please explain.

Are you currently taking any RX drugs for a medical condition or recurring disease?:

Do you have a valid driver's license?

If yes, What is the state and licence # :

State:
Licence #:

Salary Desired

(Please keep in mind that room, board & laundry services are provided and our camp season covers 54 work days and a one week orientation. In addition, our camp permits staff members to accept gratuities. In the past counselors have received gratuities ranging from $300 to over $1400.

Certifications

Red Cross Certifications

First Aid			Lifeguard
CPR			WSI
lifeguard Instructor			First Aid responder

What other certifications do you hold that might have bearing upon camp employment?

Activities:

The following is a list of the activities offered at Lake Greeley Camp. Please check the box under L for those activities you can lead and A for those activities that you can assist in teaching.

Land Sports

	L	A		L	A
Archery			Lacrosse
ATVs (Quads)			Martial Arts
Baseball			Mountain Biking
Basketball			Riflery
Cheerleading			Roller Hockey
Cricket			Skateboarding
Field Hockey			Soccer
Football			Softball
Frisbee			Tennis
Golf			Volleyball
Inline Skating			Weightlifting

Water Sports

	L	A		L	A
Canoeing			Snorkeling
Fishing			Swim Instruction
Kayaking			Windsurfing
Sailing

Gymnastics

	L	A		L	A
Balance Beam			Trapeze
Floor			Uneven Bars
Parallel Bars			Vault

Creative Activities

	L	A		L	A
Beading			Painting
Calligraphy			Paper Making
Candle Making			Photo Print Making
Cartooning			Photography
Ceramics			Potter's Wheel
Clay Work			Pottery
Dark Room			Print Making
Drawing			Puppetry
Etching			Rocketry
Fabric Arts			Router Use
Fabric Painting			Scroll Saw
Kiln Operation			Sculpture
Lanyards			Sign Painting
Leather Work			Silk-Screening
Lino/Wood Cut			Stained Glass
Macrame			Tie Dye
Mosaics			Woodworking
Needlepoint			Weaving

Dance

	L	A		L	A
Choreography			Tap
Jazz			Hip-Hop
Ballet			Modern
Point			Aerobics

Adventure Activities

	L	A		L	A
Compass Reading			Rappelling
High Ropes			Rock Climbing
Low Ropes			Zip Line
Orienteering

Theater Activities

	L	A		L	A
Acting Technique			Script Writing
Costuming			Set Construction
Directing			Set Design
Improvisation			Singing
Makeup			Stage Craft
Mime			Stage Lighting

Media Arts

	L	A		L	A
Newspaper			Sound Recording
Radio - DJ			Video Camera use
			Video Production

Equestrian Sports

	L	A		L	A
Dressage			Jumping
English			Stable Mgt
Horse care			Western

Of the activities that you indicated you could lead please indicate your preference for instructing and your experience in each Activity.

First Choice

SecondChoice

Third Choice

List any courses that you have taken that would relate to working with children:

What do you think are the most important aspects to being a good counselor?

What contributions do you think you can make to the camp and the children?

what qualities/characteristics do you feel you possess which will make you an effective counselor?

With what age group would you prefer to bunk?

Employment History

If you have not worked at a camp before, please list your employment for the past 3 summers or years.

Dates of Employment	Employer	Street Address	City	State	Zip	Position held
-
-
-

Previous Camp Employment

If you have worked at a camp previously, please complete the following information for each camp employment.

Camp Director Reference 1:
Name:		Camp Name :
Street:		Position Held:
City:		Camp Phone #:
State:		Start Date:
Zip:		End Date:

Camp Director Reference 2:
Name:		Camp Name :
Street:		Position Held:
City:		Camp Phone #:
State:		Start Date:
Zip:		End Date:

Camp Director Reference 3:
Name:		Camp Name :
Street:		Position Held:
City:		Camp Phone #:
State:		Start Date:
Zip:		End Date:

References:

Please list names and telephone numbers of 3 people who have knowledge of your abilities, experience and character. Two references should be either school or work related the other can be a character reference. This section is required in order for your application to be considered for employment at Lake Greeley Camp

Reference 1:
Name:		Day time phone #:


Street:

		Evening phone #:
City:


State:
		Relationship:

Zip:

Reference 2:
Name:		Day time phone #:


Street:

		Evening phone #:
City:


State:
		Relationship:

Zip:

Reference 3:
Name:		Day time phone #:


Street:

		Evening phone #:
City:


State:
		Relationship:

Zip:

Have you ever been convicted of any crime, including sex related or child abuse related offenses?

If yes, please explain in detail:

SUMMER: 222 Greeley Lake Rd, Greeley, PA 18425 p. 570.685.7196
WINTER: P.O. Box 219, Moscow, PA 18444 p. 570.842.3739