Counselor Application

For girls entering 8th grade & older 

Campers are ages 2-6

Please fill out the form and you will be contacted within 2 weeks. 

 
Any questions please call the Chabad office 516-295-2478
Staff Information
Name
  First
Middle
Last
 
Address
  Street
City
State
Zip
Date of Birth
   
Contact Info
  Cell Phone
Email
 

Previous Camp Experience

  Camp:

Reference Name:
Year:
Ref. Phone :
Position:

Position:
    Camp:

Reference Name:
Year: Ref. Phone :

Position:

Position:
 

Current Grade and School   Grade

School
School Attending this Fall:
 
 
Mother's name and Cell Phone
  Name
Phone
 
 Fathers Name and Cell Phone  

 Name

 Phone 

   
Questions:

 What are your strengths?

I am available the whole summer 

I am only available for part of the summer - please specify dates 

 
Current Grade and School