Camp
Legacy
Junior Counselor Program
PERSONAL INFORMATION
Name:__________________________________________________________________
Last
First
Middle
Address:________________________________________________________________
Street
(Apt)
Birthday:___________________________
City, State
Zip
School/Current Grade:______________
Contact Information:________________________________________________
Home Telephone
Mobile
How did you learn about Camp Legacy? ________________________________________________
Abilities and Talents: (List positive leadership skills and things you are good at. Example:
Good in Math)
● ______________________________________________________________________
● ______________________________________________________________________
● ______________________________________________________________________
Achievements/Awards and Clubs: (Example: Honor Roll, Perfect Attendance)
● ______________________________________________________________________
● ______________________________________________________________________
● ______________________________________________________________________
References: (List people who will say good things about you)
● ______________________________________________________________________
● ______________________________________________________________________
DATES/TIMES I CAN COMMIT TO:
JUNE:
Friday
Thursday
Wednesday
Tuesday
Monday
5
4
3
2
1
12
11
10
9
8
19
18
17
16
15
26
25
24
23
22
JULY:
Friday
CLOSED
Thursday
Wednesday
Tuesday
Monday
2
1
30
29
10
9
8
7
6
17
16
15
14
13
24
23
22
21
20
31
30
29
28
27
AUGUST:
Friday
7
Thursday
6
Wednesday
5
Tuesday
4
Monday
3
I,_____________________________________, understand that being part of the Camp Legacy
Junior Counselor Program is a responsibility, and I am committing to the dates and times I
signed up for._________________________________________________________
(Signature)
(Date)
I give permission for ________________________________________to attend Camp Legacy as
a Junior Camp Counselor on the days and times listed above.
____________________________________________________________________________
(Signature)
(Date)