Leadership Camp (PA) – Counselor Application


 

  • Personal Information

  • e.g. 123-456-7890
  • e.g. 123-456-7890
  • e.g. 123-456-7890
  • e.g. 123-456-7890
  • e.g. 123-456-7890
  • Required if you are under 18
  • Required if you are under 18
  • School Information

  • Camp Information

  • The available positions at camp include Senior Counselor, Junior Counselor, and Mariachi. Please indicate your preferences below. While we cannot promise you your first pick, we will definitely take your preference into consideration when assigning roles.
  • Medical & Photo

  • Any pertinent health information, allergies, medications, etc.
  • Parents must sign for applicants under 18 years of age.

    I hereby delegate authority to the Directors of the Leadership Camp to arrange whatever medical treatment they deem necessary for the above-named applicant during his stay at the camp. Also, I hereby authorize and consent to the use and reproduction by YSI staff or an authorized agent or assignee of any and all photographs taken of the above-named applicant for the purpose of promoting YSI programs, without any compensation to me. All film, together with any prints, shall constitute property of YSI, solely and completely.

    Enter your name above to confirm both the medical and photo release, and your registration will be complete. If you type "no", then we will have to discuss other circumstances that can be agreed to for your son to attend the camp and the registration will not be complete until we can reach an agreement.
  • Miscellaneous

  • These are adult sizes.
  • Who recommended this program to you?
  • Essays

  • 50-75 words
  • 50-75 words