Camp Counselor - New Hope for Kids

Counselor's Name
First Last
Cell Phone
Email
Date of Birth
MM slash DD slash YYYY
Age
- Male
- Female
Emergency Contact
Cell Phone
Relationship
Physician's Name
Phone Number
Please list any medical conditions that you have
Please list any allergies including reaction and treatment (drugs, food, environment, bites, etc)
Please specify any dietary restrictions
Current medications
Any medical conditions and anything that may affect your participation as a camp couselor while at camp
Are you willing swim/canoe?
- Yes
- No

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