Counselor Application 2020 - Chabad of the Five Towns

Address

Birth Date
MonthDayYear
Cell Phone Number
Area CodePhone Number
E-mail
Grade
School
I am available to be a counselor for the entire summerI am available to be a counselor for part of the summer
If available for part of the summer please list dates
Parent Information
Mother Name
First NameLast Name
Phone Number
Area CodePhone Number
Father Name
First NameLast Name
Phone Number
Area CodePhone Number
Previous Camp Experience
Camp
Year
Reference Name
First NameLast Name
Reference Phone Number
Area CodePhone Number
Should be Empty:

Parent Information