Staff
 
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Step 1/5: Personal Information
Basic Information Last Name
First Name
Sex Male Female
DOB
Physical Address Address
City
Zip
Contact Cell Phone
Home Phone
Email
Other T-shirt size (Adult Sizes) S M L XL
Step 2/5: Select Position
Please select your first, second and third choices for the sessions of camp that you are able to attend:
First Choice       
Second Choice 
Third Choice      
The Summer Camp Committee appreciates your commitment to the camp program. We wish you to know that our cost per staff member is $125. Any donation you make to our camp program is greatly appreciated and helps reduce those costs. You may make a donation payable to "Western Diocese Summer Camp" and enclose it with this application.
Tax Deductible Donation: $
 
Step 3/5: Questionnaire
High School
Grad year:
College
Major
Grad year:
Present Occupation
Are you in ACYO Yes     No
Prior years as a camper at the Diocesan Summer Camp:
Years:
Prior years & positions on staff at the Diocesan Summer Camp:
Years:
Positions
Other camp programs and/or organized child care experience (i.e. coaching, mentoring, teaching, etc.)?
If accepted, will you attend the mandatory camp preparation session on June 28th at St. Gregory church in Fowler, CA?
Yes    No
Please explain why not ...
Check the applicable boxes below if you have formal education in:
CPR
Card Expiration Date:
First Aid
Card Expiration Date:
Do you speak English? Fluently Can Survive A Little None
Do you speak Armenian? Fluently Can Survive A Little None
Do you attend church?
Yes    No
Where?
Attendance: Regularly    Sometimes     Seldom
Are you baptized in the Armenian Apostolic Church?
Yes    No
Where?
Other family members at camp this year? and Age
Please describe any medical conditions or activity restrictions that may affect you at camp?
Describe your youth organization experience, specifically church youth organization experience:
What are your extracurricular interests (including hobbies, sports, extracurricular school organizations, etc.)?
What age group do you work best with and why?

Why?
Please explain what you can contribute in the Diocese Summer Camp Program.
Please explain how you would prepare for your role.
Step 4/5: References, Emergency information, and Medical information
References (List three references of people that are active in the Armenian Church):
Name Day Phone Eve Phone
Name Day Phone Eve Phone
Name Day Phone Eve Phone
Emergency information:
Name Day Phone Eve Phone
Father's Name Cell Phone Work Phone
Mother's Name Cell Phone Work Phone
Mother's Maiden Name
Medical Information:
Doctor's Name: Phone:
Dentist's Name Phone:
Do you take any medication?
Yes    No
Type of Medication?
PLEASE NOTE: The Armenian Church Summer Camp carries accident insurance which is secondary to personal health insurance. All expenses incurred in the treatment of injuries due to accidentals or illness at camp will be the responsibility of the applicant, their parent, guardian or their assigned insurance carrier.
Do you have medical coverage?
Yes    No
Medical Insurance Company:
Policy/Group Name:    
Step 5/5: Congratulations!
Your application has been successfully created.
If you have not seen the PDF file in a new window, please turn off your pop-up blocker and press the "Create PDF" button! If you see the file in a new window, please print it, sign it, attach your donation check and your photo to it and mail to us.
Thank you!
Or you can download the PDF application form and fill it off-line
Make friends and memories that will last forever!
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