Junior Assistant Camp Imagination 2008 Application

Name__________________________________________ Date of Birth_____________ 

Address______________________________________ Phone Number______________ 

High School___________________________________________ Grade Level________ 

Email Address____________________________________________________________                      

Are you available between the hours of 7:30 a.m. and 4:30 p.m. during the following weeks?  

Week I July 7-11__________ Week II July 14-18__________

Will you have a reliable mode of transportation during Camp Imagination? ___________ 

Do you play a musical instrument (please list all)? _______________________________ 

Do you sing? __________ Do you act? __________ Do you dance? __________ 

Tell us about any work, volunteer, or extracurricular experiences you have. 

________________________________________________________________________ 

________________________________________________________________________ 

________________________________________________________________________ 

List any experience you have with children. 

________________________________________________________________________ 

________________________________________________________________________ 

________________________________________________________________________ 

Please provide us with three references. 

1. Name ____________________________________________________________ 

Relation _________________________ Phone Number ____________________ 

2. Name ____________________________________________________________ 

Relation _________________________ Phone Number ____________________ 

3. Name ____________________________________________________________  

Relation _________________________ Phone Number ____________________