LAUMC Groundlings Summer Camp
Junior Counselor Application
Summer, 2014
Name:
Social Security Number:
Date of birth:
Phone:
Email:
Address:
Please list any relevant experience:
1
Which of your skills do you feel will be most
important and useful at camp?
What is your favorite game?
What do you like to do? What extra-curricular
activities are you involved in?
What is your favorite Bible story or verse? Why is
it important to you?
2
What is your favorite age group to work with?
Circle one
K-1st
2nd-3rd
4th-5th
What weeks are you available? Circle all that
apply
July 14-18
August 5-8
July 21-25
August 11-15
July 28-31
August 18-22
Hours of availability:
Circle all that apply
Mornings: 8:45 AM-12 PM
Afternoons:12 PM-3:15 PM
The camp will be M-F from 9 AM-3 PM, however, we
will offer babysitting from 3-5:30. Would you be
interested in babysitting during this time? Yes
/ No
Notes on availability:
3
Please list 2 personal references (exclude family
members)
Name
Relationship
Phone Number
1.
2.
Please attach a letter of recommendation or have
one sent to
LAUMC
Attn: Liz Hinz
5950 E Willow
Long Beach, CA 90815
May we have permission to check your record and
references? Yes / No
I testify that my answers to the above questions are complete and
truthful to the best of my knowledge. I authorize the above
references to provide any information regarding my character and
ability to work with children. Any misrepresentation or omission
may be grounds for rejection of this application. I understand
that this information will be kept confidential.
Signature_______________________________________
Date:_____________________________
I give permission for my child to participate in the
leadership of the 2014 Groundlings Summer Camp at Los
Altos United Methodist Church as a counselor or junior
counselor.
Signature of Parent:
Date:
4