JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Camp Kesem Counselor Application Fall 2015
* Indicates required question
First and Last Name:
*
Your answer
Gender
*
Male
Female
Other:
Date of birth
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Address
*
Your answer
School address
*
Your answer
What is your anticipated graduation year?
*
Your answer
Which of the following age groups would you be interested in working with?
*
6-8
8-10
12-14
14-16
Have you ever attended Camp Kesem as a camper?
*
Yes
No
What sort of experiences do you have working with children aged 6-16?
*
Your answer
Why do you want to work with children who have been affected by a parent's cancer?
*
Your answer
Do you have any special skills or qualities that would make you a particularly effective Camp Kesem volunteer?
Your answer
Is there anything else you think we should know about you or your desire to volunteer with Camp Kesem?
*
Your answer
Do you speak any languages other than English?
*
Your answer
Do you hold any special certifications?
*
Your answer
Reference #1
*
Include name, phone number/ email, and relation to you.
Your answer
Reference #2
*
Include name, phone number/ email, and relation to you.
Your answer
Reference #3
*
Include name, phone number/ email, and relation to you.
Your answer
Have you ever been arrested, convicted, or charged with a crime?
*
Your answer
How did you hear about Camp Kesem Illinois?
*
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Camp Kesem National.
Report Abuse
Forms
