Summer Assembly

 

 

 Volunteer Counselor Application

 

Please Print and mail to:

Karen Nelson

1907 Wesbrook Circle

Hutchinson, Ks 66103

Or email summerassemblycamp@hotmail.com with this information

 

 

Name         Date

 

 

Address

 

 

City     State         Zip

 

 

Home Phone  

 

 

Work Phone

 

 

Cell Phone      

 

 

Email

 

 

Gender Male   Female                      Age

 

 

 

 

Do you fulfill all of the Counselor requirements? Yes   No

Do you feel as if you will be able to meet all of the Counselor responsibilities? Yes   No

Are you available for the entire week of Summer Assembly? Yes    No

 

 

 

References

If you are new to Summer Assembly, please supply us with at least one reference (non-family members only)

Name

Address      City      State      Zip

Phone       Please specify Home   Work   Cell

How they know you        How long they’ve known you

 

 

Name

Address      City      State      Zip

Phone       Please specify Home   Work   Cell

How they know you        How long they’ve known you

 

 

Name

Address      City      State      Zip

Phone       Please specify Home   Work   Cell

How they know you        How long they’ve known you

 

 

Name

Address      City      State      Zip

Phone       Please specify Home   Work   Cell

How they know you        How long they’ve known you