Welcome to Kippewa Apply Now! Staff Reference Form Staff 2008 1st Year Staff Returning Staff International Staff Important Dates Forms & Information Online Travel Form What to Bring		REQUEST INFORMATION | SUMMER 2007 PHOTOS | HOME Apply now! Summer Camp Staff (Counselor) Application Last Name: First Name: Nick_Name: U.S. Soc. Sec. #: Home Address: Line 1: Line 2: City: State: Zip: Home Phone: Address While at University: (if different than home) Line 1: Line 2: City: State: Zip: College/Business Phone: Which address should we send mail to: ? Home Address Address at University Until - Date: E-Mail Address:   Full Time Student: ? YES NO If no, Occupation: This section is optional. Age: Height: Gender: ? Female Male Marital Status: ? Single Married Divorced Do you have children that must accompany you to camp? ? YES NO Children if any (please indicate sex and age): Salary requirements: How did you hear about our camp?   ACTIVITIES Using the list of activities below: List those activities which you can organize and teach. List those activities where you feel you can assist confidently and competently. Fine Arts & Crafts Ceramics Potter's Wheel Jewelry Silver Smithing Leather Sewing Silk Screen Block Printing Wood Working Stained Glass Sculpture Weaving Paper Making Drawing Painting Gymnastics Floor Vault Beam Bars Waterfront Swim Instruction Lifeguarding Water Skiing Wake Boarding Ski Boat Driver Sailing Wind Surfing Canoeing Kayaking Fishing Tennis Athletics Archery Soccer Softball Basketball Volleyball Field Hockey Lacrosse Rugby Equestrian English Balanced Seat Modified Hunt Seat Hunt Seat Dressage Seat Vaulting Western Theater Play Direction Scenery Costumes Lighting Make-up Music Piano Guitar Song Leader Sight Reading Dance Jazz Modern Ballet Hip Hop Aerobic Media Yearbook Newspaper Film / Video Digital Photography Traditional Photography/ Film Development Outdoor Adventure & Activities Camping Trips Canoe Trips Hiking Trips Climbing Wall Nature In addition to the activities listed above, Kippewa wants to know about any unusual skills you may have. For example, in recent years, Kippewa has taught karate, origami, puppetry, book binding, cricket, knitting, synchronized swimming, ultimate frisbee, and fancy baton twirling. Let us know about other activities which you could lead: Select your top three choices in order of preference from the above list: First choice: Second choice: Third choice: Do you have a valid: WSI? ? YES N0 Lifeguard Certificate? ? YES NO CPR? ? YES NO First Aid? ? YES NO Check for experience with: Boat Driver, Canoeing, Kayaking, Sailing, Water-skiing, Windsurfing   EDUCATION Select level of education completed at close of current academic year: College select one first year second year third year fourth year completed Graduate School select one first year second year third year fourth year completed High School City & State Years Colleges City & State Years Major/Degree   PAST EMPLOYMENT Include camp, coaching and teaching experience. *Camp, coaching or teaching experience not necessary for employment. Employer Contact Person Nature of Work Phone or Email Please describe your experience in a specific program area you would like to teach at camp (i.e. certifications, training, team play). Please describe any experience you have that would make you a successful camp counselor. HAVE YOU EVER BEEN ARRESTED FOR AND/OR CONVICTED OF CHILD ABUSE? ? YES NO The statements in this application are true, complete and correct. I understand that any misrepresentation or omission of information shall be considered sufficient reason for withdrawal of an offer or subsequent termination of employment. I hereby authorize Camp Kippewa to conduct a personal felony record search. Please type the code shown in the image: By electronic submission of this application to Camp Kippewa, I understand and agree to the conditions stated above.

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	Kippewa for Girls • Visit our brother camp – CAMP COBBOSSEE, a boys summer camp
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