RETURN TO: Chuck Bennis Ph:
(605) 336-3190
Sioux Falls Family YMCA Fax:
(605) 336-3516
230 S. Minnesota Ave Email: cbennis@siouxfallsymca.org
Sioux Falls SD 57104
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SIOUX FALLS YMCA CAMPS
COUNSELOR APPLICATION
230 S Minnesota, Sioux Falls, SD 57104
Name_______________________________Date of Birth______________________
Address______________________________________________________________
State______________Zip_________Sex________
Home Phone________________________ School Phone______________________
Mobile Phone________________________ Alternate number___________________
Email Address______________________________________
High school attended________________Year of graduation_________ GPA_______
College: attending - attended - will attend ______________________________________
Location___________________Class in college F____S____J____S____G____
Major(s)___________________ Minor__________________________GPA_______
Leadership experiences in high school or college______________________________
_____________________________________________________________________
Organizations or activities in high school or college ____________________________
_____________________________________________________________________
_____________________________________________________________________
Experiences in organized youth groups or
volunteering ____________________________________________________________
______________________________________________________________________
Community groups and activities___________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Ever been a camper?____ If yes, where and when?_____________________________
______________________________________________________________________
______________________________________________________________________
Why do you feel a camping experience is important for youngsters?________________
______________________________________________________________________
______________________________________________________________________
From whom/where did you hear about Sioux Falls YMCA camps?_______________________________________________________________________________________
Why do you want to serve in a Sioux Falls YMCA summer camp?_______________________________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Can you lead a group in singing?____Give a chapel talk?____Teach a camping skill? ______Teach a craft?__
Write a childrens' poem?____Shoot a bow and arrow?___
Identify plants and animals? ___ Develop a funny, tastful, enjoyable skit for campers to
do? ___ Ride a horse? __Row a boat? __
Maintain your composure in a storm? ___
Treat children with respect and patience?_____ Follow directions from a supervisor? ____ Use a camera?
___ Put a worm on a fishing hook? __
Do
you mind doing silly and funny things in front of a large group?_________________
What musical instruments (if any) do you play (or acting experience)?_______________
What languages do you speak? (including Sign Language) ________________________
Are you up-to-date on CPR training?____ First Aid?____ Would you be willing to be
trained to drive a bus?____ Do you have a commercial drivers license?____
Are you certified as a life guard?____ Do you work easily with others?____
List other skills you feel could help you in working with campers and fellow staff. _____________________________________________________________________________
_______________________________________________________________________
Have you ever been charged with, or convicted of any offense involving immoral
behavior?____________If yes, explain________________________________________
_______________________________________________________________________
Have you ever been charged with, or convicted of a felony?____If yes, explain _______________________________________________________________________________
Have you ever been charged with, or convicted of drug possession, illegal alcohol consumption or possession, or DWI?____If yes, explain__________________________
_______________________________________________________________________
Do you use tobacco products?
_______________________________________________________________________
Do you have any outdoor allergies that we need to know about ? ___ If so, specify __________________________
What jobs have you held?
1. Employer____________________ Position____________________ Dates__________
Employer’s Address_______________________________ Phone_________________
2. Employer____________________ Position____________________ Dates__________
Employer’s Address_______________________________ Phone_________________
3. Employer____________________ Position____________________ Dates__________
Employer’s Address_______________________________ Phone_________________
References (Other than relatives)
Name Address Phone
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
To the best of my knowledge, the information I have entered on this form is true
and accurate.
Name______________________________________________ Date_______________________