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Staff Application

In accordance with the Children's Online Privacy Protection Act, a person must be 13 years of age or older to complete and submit this form.

Camp Half Moon On-Line Staff Application

PHOTO REQUIRED
Please mail or e-mail current photo to: info@camphalfmoon.com
Camp Half Moon for Boys & Girls
P.O. Box 188 Great Barrington, MA 01230

Please Fill Out & Complete All Fields
Note: Use "TAB" Key and/or Pointer to Move Between Fields

Name:
Current Address:
City:
State:
Zip:
E-mail:	*required
Phone:
SSN:
Date of birth (MM/DD/YY):
Expiration date of current address (MM/DD/YY):
Permanent Address:
City:
State:
Zip:
Phone:
List any physical limitations:
Have you ever been investigated for child abuse or any sex related crimes?	Yes No
Do you smoke?	Yes No
Do you engage in the use of illegal drugs?	Yes No
Please state the position for which you would like to be considered.
Position Desired:
BACKGROUND
Education
School/College:
Dates Attended:
Major:
Degree:

School/College:
Dates Attended:
Major:
Degree:

School/College:
Dates Attended:
Major:
Degree:
Work Experience
Job Title:
Employer:
Telephone:
Dates (From-To):
Responsibilities:

Job Title:
Employer:
Telephone:
Dates (From-To):
Responsibilities:

Job Title:
Employer:
Telephone:
Dates (From-To):
Responsibilities:

Leadership Experience (describe)

Camp Experience as a Camper or Camp Staff Member
	Camper Staff
Camp Name:
Employer:
Telephone:
Dates:
	Camper Staff
Camp Name:
Employer:
Telephone:
Dates:
	Camper Staff
Camp Name:
Employer:
Telephone:
Dates:

Current Certification
List certificates you hold in aquatics, first aid/medical, small craft, campcraft, sports & others that may apply
Certification:
Expiration Date:

Certification:
Expiration Date:

Certification:
Expiration Date:

Certification:
Expiration Date:

AREA OF EXPERTISE In the following list, place a "1" before all of the activities you are able to organize and teach; "2" if you can assist in teaching; "3" if it is a hobby.

Performing Arts

Ballet:
Folk Dance:
Modern/Jazz Dance:
Song Leader:
Instrumental Music:
Piano:
Guitar:
Directing:
Skits:
Set Design:

Waterfront

Canoeing:
Kayaking:
Sailing:
Snorkeling:
Swim Instructor:
Waterskiing:
Motor Boat Driver:
Wind Surfing:

Support Service

Health Care:
Food Service:
Maintenance:
Driving:
Office Skills:

Sports

Aerobics:
Archery:
Baseball:
Basketball:
Skateboarding Instructor:
Street Hockey:
Football:
Group Games:

Gymnastics:
Floor Exercise:
Tumbling:
Uneven Bars:
Balance Beam:
Vault:

Horseback Riding:
Lacrosse:
Judo:
Soccer:
Softball:
Tennis:
Track/Field:
Volleyball:
Wrestling:

Nature/Science

Gardening:
Nature Study:
Radio/Electronics:
Rocketry:

Arts & Crafts

Ceramics/Pottery:
Crafts:
Jewelry Making:
Journalism:
Metal Work:
Copper Enameling:
Stained Glass:
Basketry:
Woodworking:
Tie Dyeing:
Batik:
Puppetry:
Silk Screen:
Nature Craft:
Other:

Adventure

Backpacking:
Bicycle Trips:
Nature Hiking:
Orienteering:
Overnight Camping:
Ropes Course:
Survival Skills:

Describe your experiences or training which may have bearing on the position for which you are applying.

How are you well suited to work in a camp community?

How do you hope your camp experience will enhance your own life?

References
List 3 individuals, not related to you, who have knowledge of your character, experience, and ability.
Name:
Address:
City/State/Zip:
Phone:
Position:

Name:
Address:
City/State/Zip:
Phone:
Position:

Name:
Address:
City/State/Zip:
Phone:
Position:

I authorize investigation of all statements herein, including any checks of criminal records and release the camp and others from liability connection with the same. I understand that untrue, misleading or omitted information herein or in other documents completed by the applicant may result in dismissal, regardless of the time of discovery by the camp.

Recent News & Events

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Parent's Weekend: July 24 and 25

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Overnight Camp Brochure

Day Camp Brochure

Community Links:

Camp Half Moon for Boys & Girls | P.O. Box 188 Great Barrington, MA 01230 | Phone: (413) 528-0940 | Fax: (413) 528-0941 | Email: info@camphalfmoon.com

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