New Counselor Application New Counselor Application Date MM slash DD slash YYYY Last four digits of your Social Security NumberLast Name First Name Birthdate MM slash DD slash YYYY Street AgeMarital Status City State ZipOccupation Name of Employer Number 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 ContactRelationship PhoneT-Shirt Size Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Do you have certification in the following? CPR First Aid Life Guard Nurse EMT Do 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 Name Date of Graduation MM slash DD slash YYYY College Major Date of Graduation MM slash DD slash YYYY Other Major Date of Graduation MM slash DD slash YYYY PERSONAL REFERENCES (not relatives)Name Address PhoneName Address PhoneName Address PhonePhoneThis field is for validation purposes and should be left unchanged.
