First Name: *


Last Name: *


Email: *


Date of Birth (d/m/yy) *


Home Address: *


City: *


Province: *


Postal Code: *


Telephone:


Cell Phone:


School Address:


City:


Province:


Postal Code:


Telephone:


Dates at this address:


Are you currently attending school? *
Yes
No

Major/Specialization/Course: (if applicable)


Highest grade/degree completed by June 2010: *
Grade 10 Grade 11 Grade 12 High School Graduate First Year College/University Second Year College/University Third Year College/University Diploma/Undergraduate Degree Post-Graduate Student

Please explain your experience with residential summer camp programs (have you attended camps in the past? how many years have you been on staff?) *


Please outline your qualifications and teaching experience you have (e.g. First Aid, CPR, Lifeguard qualifications, Canoeing, etc.) *


Activities at Lambton Centre in which you could provide leadership, please list at least five: *


Where do you think your skills and abilities would best be used for 2010? Please fill in the positions below (e.g. Counsellor, Program Director, Christian Education, Integration Coordinator, Lifeguard etc.). Please note that these positions are not guaranteed and we will place staff into the positions that best help the camp serve the campers. *


Are you committed to upholding the policies of Lambton United Church Centre including Zero Tolerance for Alcohol, Drugs and any Tobacco products? *
Yes
No

Have you ever been convicted of a criminal offense for which a pardon has not been grated? *
Yes
No

Are you available for the entire season (May 5 - August 27, 2009)? *
Yes
No

If no, what weeks are you not available?


If no, when are you available?


When are you available for an interview?