Camp Staff Application - The Shul of Bellaire

Address*

Home Number*
School you attend: *
Grade entering in Fall of 2026 :
If Other, please specify:*
Which week/s are you interested in applying for?*

Week One: June 29 - July 3Week Two: July 5 - July 10Week Three: July 13 - July 17Week Four: July 20 - July 24
Do you have CPR certification?*

YesNo
If yes, when does it expire?*
Have you been a counselor or worked with children before? Please describe:*
Which type of camp activities do you see yourself leading? Please describe:*
What are your preferred age groups?*
T-Shirt Size*
Extra shirts:
Parent's Information:
Parent 1 Name*
First Name Last Name
Parent 1 E-mail*
Parent 1 Phone Number*
Parent 2 Full Name
First Name Last Name
Parent 2 E-mail
Parent 2 Phone Number
References:
Please list 2 references below.
Full Name*
First Name Last Name
E-mail*
Phone Number*
Relationship:*
Full Name*
First Name Last Name
E-mail*
Phone Number*
Relationship*
Emergency Contact:
Full Name*
First Name Last Name
E-mail*
Phone Number*
Relationship to Applicant:*
I would like to receive news and updates by email
Should be Empty:

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Applicants Information: