2019~ Application for future Staff

To apply for a position at Valley Vista Summer Camp please fill out the form below.
Personal
Name: *

First Name Middle Name Last Name
E-mail Address: *
Birth Date *

Month Day Year
Age *
Marital Status: *

Single Married Divorced Separated

Permanent Address: *

School Address

Do you have any Commitments for next summer ? *
Have you ever been arrested and/or convicted of a crime involving drugs, sex or violence? *

Yes No
If you answered yes the above questions please explain.
Training or Certifications:
lifeguard, ropes course ect.

Education

(List Current and Previous Educational Experience.)
Education 1

Years School Major Subjects Degree Granted
Education 2

Years School Major Subjects Degree Granted
Past Employment

(List Current and Previous Educational Experience.)
Past Employment 1

Dates Employer Address / Phone Nature of Work Supervisor
Past Employment 2

Dates Employer Address / Phone Nature of Work Supervisor
Camp Experience & Desired Position
Camp Experience & Desired Position 1

Dates Camp Director Describe your Experience Camper or Staff
Camp Experience & Desired Position 2

Dates Camp Director Describe your Experience Camper or Staff

Summer Camp Schedule
Please Check weeks you are available for work *

June 9-14 -Camp Pitch/Life Guard Camp (Age 15+) June 14-22 -Camp Meeting June 23-30 -Camp Staff Orientation June 30-July 7 -Teen Camp (Ages 13-16) July 7-14 -Junior Camp (Ages 10-12) July 14-21 -Adventure Camp (Ages 7-9) July 21-24 -Family Campout/ Blind Camp July 24-26 -Camp Clean-up (Required)
Health
What Allergies do you have? List any if applicable *
Any medical conditions? e.g. diabetes, asthma, etc... *
Date of last TB test

Month Day Year
Last injury or operation:
Also include the date
Who should be contacted in case of emergency *
Relationship of emergency contact *

Address of Emergency Contact *

Cell Phone Number of emergency contact *

Area Code Phone Number
Please upload a copy of your school health card or recent medical examination (If you need to mail it please send it the the address below)
Paid staff members will be covered under West Virginia Workmen's Compensation in case of accident. Please upload a copy of the family's health insurance card in case of illness (If you need to mail it please send it the the adress below)
If you have any questions or comments please call Jason Johnson at 517-416-2418 or email summercamp1218@gmail.com

Valley Vista Summer Camp Website- www.vvscamp.com

Address to send forms,

1400 Liberty St.

Parkersburg, WV 26101
This Portion must be completed if staff member is under 18 years of age.
VALLEY VISTA CAMP DIRECTOR or his designee, has my permission to administer any emergency treatment necessary for my child, _________________.
Parent's Signature

Clear
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