Camp Counselor Registration Form • Silver Heights

CAMP COUNSELOR REGISTRATION

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Email
College Major/Minor
Have you read and agree with our Core Values?
- YES
- NO
Are you willing to let us do a background check, including a sex offender registry?
- YES
- NO
Signature
Date
MM slash DD slash YYYY