2018 Counselor Application

Please completely fill-out this application to assist us in reviewing your Counselor Application.

We have limited space available and applications are not accepted until fully completed.

After submitting this application, you will be contacted by a Head Counselor who will notify you regarding the status of your application. If you do not hear within two weeks of submitting your application, please contact headcounselors@campcasey.org.

New counselor applicants who attend our picnic on Saturday, May 12, noon to 2:00 will be given priority. If you are unable to attend the picnic you will be contacted for an interview or alternative group camper/counselor activity which can take the place of the picnic. The picnic is a fun interactive way to experience the Casey spirit and serves as an “interview in action."

Once you have received your confirmation email, confirming your acceptance as a counselor for Kiwanis Camp Casey, you will receive information about the three counselor training sessions, scheduled the three Monday evenings before camp. While we prefer you can attend all three sessions, please communicate any conflicts to your Head Counselors so they can make alternative arrangements for your training.

If anything regarding the information you provided between now and the start of camp changes, please, ASAP, contact headcounselors@campcasey.org . Last minute counselor cancelations can cause great hardship for the safety and planning for camp. Please understand you are making a commitment that will be life-changing for you and the campers you will be serving.
Will you be between the ages of 15 and 26 years old on August 4, 2018?*
- Yes
- No
Due to the popularity and accommodations for counselors, we have to limit the number of counselors to those between the ages of 15 and 26 years old at the time of camp.

We regret to inform you, based on your age we cannot accept your application as a counselor for Kiwanis Camp Casey. Though a most rewarding experience, Kiwanis Camp Casey demands maturity, is a physically exhausting experience and our campers enjoy interacting with age like peers. However, if you are younger than 16 we do encourage you to volunteer at our May picnic or explore volunteering for Seattle Adaptive Sports or the Crew.

Seattle Adaptive Sports or Seattle Adaptive Sports - The Crew Youth Social both experiences will give you wonderful opportunities meeting our Casey campers and better prepare you if you decide to reapply as a counselor when you turn 16 or older.

If you are older than 26 years of age we encourage you to consider joining North Central Seattle Kiwanis

If you have any questions or concerns please email director@campcasey.org

Please completely fill-out this application to assist us in reviewing your Counselor Application.

We have limited space available and applications are not accepted until fully completed.

After submitting this application, you will be contacted by a Head Counselor who will notify you regarding the status of your application. If you do not hear within two weeks of submitting your application, please contact headcounselors@campcasey.org.

New counselor applicants who attend our picnic on Saturday, May 12, noon to 2:00 will be given priority. If you are unable to attend the picnic you will be contacted for an interview or alternative group camper/counselor activity which can take the place of the picnic. The picnic is a fun interactive way to experience the Casey spirit and serves as an “interview in action."

Once you have received your confirmation email, confirming your acceptance as a counselor for Kiwanis Camp Casey, you will receive information about the three counselor training sessions, scheduled the three Monday evenings before camp. While we prefer you can attend all three sessions, please communicate any conflicts to your Head Counselors so they can make alternative arrangements for your training.

If anything regarding the information you provided between now and the start of camp changes, please, ASAP, contact headcounselors@campcasey.org . Last minute counselor cancelations can cause great hardship for the safety and planning for camp. Please understand you are making a commitment that will be life-changing for you and the campers you will be serving.
Contact Information
How did you hear about camp?*
Have you volunteered for Kiwanis Camp Casey Before?*
- Yes
- No
How many years have you volunteered as a counselor?*
When was the last year you volunteered?*
If referenced, what organization/who referred you to Camp Casey?
Please specify any prior experience in service clubs.
Name*
First Last
Date of Birth*
Sex*
- Male
- Female
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone (home)*
Phone (work)
Phone (cell)
Is your Current Address different than the permanent address you already listed?*
- Yes
- No
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Contact Information
Name*
Name Relation Phone
Parent/Guardian Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Best Phone*
Alternate Phone
Email
Emergency Contact
Is your Emergency Contact the same as your Parent/Guardian?*
- Yes
- No
Name*
Name Relation Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Daytime Phone*
Evening Phone*
Email
Education and Work History
Name/Location of High School*
High School Information*
Please indicate last grade completed.
- 9th Grade
- 10th Grade
- 11th Grade
- 12th Grade
Graduation Year*
Do you have another educational institution to report such as college or university?*
- Yes
- No
Name/Location of School*
Course of Study/Major*
Graduation Year*
Type of Degree/Certification*
Have you had any work experience?*
- Yes
- No
Employer Name*
Position Title*
Start Date*
Is this your current employment?
- Yes
- No
End Date*
Duties and Responsibilities*
Do you have any experience working with children or adults with special needs?*
- Yes
- No
Please write about your experience*
Describe briefly an experience where you faced a challenge and how you resolved it.*
Describe briefly an experience where you had to show leadership qualities.*
Describe briefly an experience where you had to use teamwork to succeed:*
References
Please provide 2-3 personal references that we may contact to learn a bit more about you (no relatives, please):
Reference 1 Name*
First Last
Reference 1 Phone*
Reference 1 Email*
Reference 2 Name
First Last
Reference 2 Phone
Reference 2 Email
Reference 3 Name
First Last
Reference 3 Phone
Reference 3 Email
Camp Activities
Please indicate the areas you have experience with:
Story Telling*
- Yes
- No
Arts and Crafts*
- Yes
- No
Drama/Skits*
- Yes
- No
Organized Sports*
- Yes
- No
Music/Play an instrument*
- Yes
- No
Music/Play an instrument Details*
Campfires (music, stories, skits)*
- Yes
- No
**Interest Groups** Science and Nature - You do science experiments and take nature walks. Drama and Music - Put on a skit or play a concert. Cooking - Stir up a master piece in the mess hall. Casey Yearbook (photography) - Work with campers throughout the week to photograph various events and assemble a memento of Camp Casey 2017 Arts & Crafts - Get your creative side roaring. Sports - Let's get active. ###Please do not select the same choice multiple times
Interest Groups- First Choice*
Interest Groups- Second Choice*
Interest Groups- Third Choice*
**Activity Groups** Olympics - Ceremonies, Events, and Gold Medalists. Dance - Boogie the night away with our DJ and dozens of cookies. Talent Show - An epic showing of song and dance. Graduation - Celebrating the Graduates and memories from over the years. Contender - Only the best can take home the Belt. Carnival - Ice cream, Dunk tank, and Prizes galore. Something Awesome - Create and unveil the newest camp craze! ###Please do not select the same choice multiple times
Activity Groups- First Choice*
Activity Groups- Second Choice*
Activity Groups- Third Choice*
Are you available to help with planning camp entertainment activities before camp?*
- Yes
- No
Are you available to help with camp set up on Saturday, July 28?*
- Yes
- No
Will you be able to attend the Camp Casey Annual picnic on May 12th?*
- Yes
- No
Please provide any other information you would like to share:.
Camp Casey T-Shirts
Please provide us with your t-shirt size so we an provide you a t-shirt.
- Small
- Medium
- Large
- X-Large
- XX-Large
- XXX-Large
Health Information
*
- I understand that the Volunteer, Kiwanis Camp Casey Head Nurse is primarily responsible for the medicine and health care plan provision for the campers. All counselors and volunteers must be mature enough to take responsibility for administration of their own personal medications, and must safely keep their personal medications with their own living space. The Head Nurse is responsible for the first aide needs and emergencies of all the camp, and is available to volunteers/ counselors if over the counter (OTC) medications are needed. Therefore, the separate release form must be signed by all counselors and volunteers or parent/guardians in the case of underage counselors, younger than 18. The information provided in the medical history will be kept in a confidential location, available to the Kiwanis Camp Casey Medical trained leader volunteers only, and to the extent any information is designated as protected health information under the Health Instructions ADD/ADHD Details Insurance Portability and Accountability Act (HIPAA), Kiwanis Camp Casey agrees to abide by all applicable laws.
Please list all prescription medications you are taking.
ADD/ADHD*
- Yes
- No
ADD/ADHD Details*
Anxiety/Depression*
- Yes
- No
Anxiety/Depression Details*
Asthma*
- Yes
- No
Asthma Details*
Back/Neck Pain*
- Yes
- No
Back/Neck Pain Details*
Diabetes*
- Yes
- No
Diabetes Details*
Eating Disorder*
- Yes
- No
Eating Disorder Details*
Emotional Problems/Self Injurious Behavior*
- Yes
- No
Emotional Problems/Self Injurious Behavior Details*
Headaches*
- Yes
- No
Headaches Details*
Heart Conditions/Problems*
- Yes
- No
Heart Conditions/Problems*
Hepatitis/Hepatitis Exposure*
- Yes
- No
Hepatitis/Hepatitis Exposure Details*
Seizures/Convulsions*
- Yes
- No
Seizures/Convulsions Details*
Auto Immune Condition*
- Yes
- No
Auto Immune Condition Details*
Other*
- Yes
- No
Other Details*
Are you currently being seen (or been seen in the last 3 years) by a psychiatrist, psychologist, therapist or any other related specialist for any acute or chronic mental health condition?*
- Yes
- No
Please Provide Details*
Do you have any medical, mental or emotional conditions which may affect your ability to perform any of the essential functions of a Kiwanis Camp Casey Counselor?*
- Yes
- No
Please Provide Details*
Have you had any recent operations or serious injuries?*
- Yes
- No
Please Provide Details*
Have you been exposed to a communicable disease (e.g. head lice, strep throat, mononucleosis, etc) in the last six (6) months?*
- Yes
- No
Please Provide Details*
Our staff are involved in an active program. Counselors will need to physically assist campers, lift campers, and push wheelchairs used by campers, as well as participate in activities such as dancing, swimming, and running. Do you have any physical, medical, or other type of condition which we need to know about related to these responsibilities?*
- Yes
- No
Please Provide Details*
Dietary*
Note: The Camp Casey kitchen staff will do their best to accommodate common food allergies. However, given the complexity and procedures for vegan diets the kitchen staff will no be able to provide vegan meals. Sorry for the inconvenience.
- Gluten Intolerant
- Lactose Intolerant
- Vegetarian
- No Food Restrictions
Legal
Have you been accused of harassment of any person?*
**Harassment:** The camp's policy is to prohibit all forms of harassment by our counselors, volunteers and campers. This includes sexual, racial, religious, and other forms of harassment.
- Yes
- No
Please Explain
A prior accusation is not an automatic bar to volunteer at Kiwanis Camp Casey. The type of conviction and when it occurred will be evaluated by the camp before a decision is made.
Have you ever been convicted of a crime, other than a minor traffic offense?*
**Criminal Record**
- Yes
- No
Please Explain*
A prior conviction is not an automatic bar to volunteer. The type of conviction and when it occurred will be evaluated by the camp before a decision is made.
Background Check*
I understand my application is not complete until Background check has been completed by Camp Staff.
- Pursuant to requirements of RCW 43.43.834 Washington state rules. I authorize investigation of all statements herein and release Kiwanis Camp Casey and all others from liability in connection with same. I understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.
Acknowledgement
Please read and agree to the forms below.
Please read Camp Casey Counselor Volunteer Code of Conduct.*
- I have reviewed the Counselor Volunteer Code of Conduct. I know what is expected and agree to the guidelines specified.
Please read Camp Casey Counselor Volunteer Release Form.*
- I have reviewed the Volunteer Release Form. I know what is expected and agree to the guidelines specified.

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Contact Information

Parent/Guardian Contact Information

Emergency Contact

Education and Work History

References

Camp Activities

Health Information

Legal

Acknowledgement