Deer Mountain Day Camp - Your Child's Summer Home

Contact Information:
	(*Denotes required fields)

First Name:*
Last Name:*
Date of Birth:
Home Address 1:*
Home Address 2:
City:*
State:*
Zip Code:*
Home Phone:*
Email Address:
Contact Information at School/College (if applicable):
College Address 1:
College Address 2:
City:
State:
Zip Code:
College Phone:
College Email:
Educational Information:
Current Grade in School:*
High School:
Dates Attended:
College/University:
Dates Attended:
Major/Field of Study:
Graduate School:
Dates Attended:
Major/Field of Study:

Tell Us More About You:

How did you hear about Deer Mountain?

What type of position are you looking for?

If you are interested in working as a general counselor or group leader, what age group would you like to work with?

If you are interested in being a specialty leader, athletic director, or specialty assistant, please check off the specialty areas that you feel most qualified to teach.

Music	Ceramics	Martial Arts	Basketball	Softball
Drama	Photography	Gymnastics	Football	Lacrosse
Dance	Woodworking	Tennis	Soccer	Low Ropes/Challenge Course
Nature & Pioneering	Cooking	Golf	Volleyball	Swim
Creative Arts	Radio/Computers	Archery	Hockey	Fitness

Do you hold any of the following certifications? (check all that apply)

LGT	Expires
First Aid	Expires
CPR	Expires
WSI	Expires
RTE	Expires

What types of hobbies, interests or sports do you pursue in your spare time?

There are a number of different things you can do with your summer, why are you interested in spending it at a camp, working with children?

Camp Experience:
Did you go to camp when you were younger? Yes No
If yes, where did you go?
Have you ever worked at a camp before? Yes No
If yes, please complete the following information:
Camp Name:
Summers Worked:
Director:
Phone:
Reason for Leaving?

Camp Name:
Summers Worked:
Director:
Phone:
Reason for Leaving?
Non-camp Work Experience or Volunteer Experience:
Employer:
Dates Worked:
Position:
Supervisor:
Phone:
Reason for Leaving?

Employer:
Dates Worked:
Position:
Supervisor:
Phone:
Reason for Leaving?
References:

Please provide us with the names, addresses and phone numbers for two people we can call to learn more about your character and work ethic. You can refer us to a coach, teacher, guidance counselor or person that you baby sit for if you do not have another type of work reference. Family members can not serve as your reference.

Name:
Address:
Address:
City:
State:
Phone:

Name:
Address:
Address:
City:
State:
Phone:

Final Questions: (Responses Required)

1. Have you ever been accused of or involved in an incident involving sexual or physical abuse of a child? Yes No

2. Have you ever been convicted of a felony? Yes No

3. If you answered "yes" to either of the last two questions, please explain.

Authorization:

You must check off your authorization before you submit your form.

I state that the information provided on this application is correct. I permit the camp to investigate all statements herein and release the camp and all others from liability in connection with the same. I understand that if hired for a position at Deer Mountain Day Camp, providing false information on this application would be cause for dismissal.

Who We Are Facilities Activites Program Staff Info Tour Dates Contact Us DMDC News Request Information Home