New Counselor ApplicationNew Counselor ApplicationDate MM slash DD slash YYYY Last four digits of your Social Security NumberLast NameFirst NameBirthdate MM slash DD slash YYYY StreetAgeMarital StatusCityStateZipOccupationName of EmployerNumber of yearsHow long have you lived in CT?f you have lived in CT for less than five years, list your complete addresses for the last five years:Best Contact Phone NumberEmail Emergency ContactRelationshipPhoneT-Shirt Size Adult Small Adult Medium Adult Large Adult X-Large Adult XX-LargeDo you have certification in the following? CPR First Aid Life Guard Nurse EMTDo you have previous training or background in dealing with abused, neglected or abandoned children?Were you a victim of abuse, neglect, or abandonment as a minor?Please describe why you wish to be a volunteer for Royal Family KIDS Camp?Do you have any medical conditions or concerns, or are you taking any medications that you believe could prevent you from being an effective volunteer that we need to know about in order to help you be effective at camp? RECORD OF EDUCATIONHigh School NameDate of Graduation MM slash DD slash YYYY CollegeMajorDate of Graduation MM slash DD slash YYYY OtherMajorDate of Graduation MM slash DD slash YYYY PERSONAL REFERENCES (not relatives)NameAddressPhoneNameAddressPhoneNameAddressPhoneNameThis field is for validation purposes and should be left unchanged.Δ
