Please select one: ---Full SummerSession OneSession Two
First Name:Last Name:
Street Address:City:State:ZIP Code:
Cell Number: Phone Number:
Birthdate (mm/yy/dd): Current Grade:101112Post HSCurrent Age:
High School:Years Attended:
If attending college, will your college / exam schedule interfere with the camp schedule?---YesNo
What camps have you attended as a camper?
What camps have you attended as a staff member?
List any other work-related experiences:
What type of position are you applying for? (List in order of preference)
If applying as counselor, what age group would you prefer? (We can not guarantee any age group)
If you are only applying for one month, what are your plans for the other month? (If applying for full summer, write n/a)
Do you hold a current lifeguarding certificate? If yes, please describe.
Do you play a musical instrument? If yes, please describe.
Do you have any other special talents? If yes, please describe.
What do you think a counselor's job in camp should be?
Why did you choose to apply to Camp Dina?
Please check those activities that you can teach as an expert, and those in which you can assist in teaching:
Please upload a recent photo of yourself here:
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Phone: (718) 437-7117
Fax: (718) 437-7644