Leadership Camp (PA) – Counselor Application

Personal Information
Name*
First Last
City*
State*
Home Phone Number
e.g. 123-456-7890
Applicant Cell Phone
e.g. 123-456-7890
Applicant Email*
Date of Birth*
Month
Day
Year
School Information
School*
Grade (entering next fall)*
Camp Information
Have you attended the Leadership Camp before?*
- As a camper
- As a counselor
- As both
- As neither
Miscellaneous
Reference

Who recommended this program to you?
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