Family Farm Junior Counselor Application Summer 2009

          18448 Hwy 67 / Malvern, AR. 72104 / Ph# 501-337-4171   www.familyfarm.org       

Family Farm is a Christian summer day camp for children, ages 6-12. The camp has been blessed in having some of the finest young men and women to serve as Junior Counselors. Family Farm Jr. Counselors must be of high moral character, exhibit leadership qualities, enjoy working with kids, have sound Christian values and be positive role models for our campers. Dress is one important way to demonstrate this positive role model. The dress code at Family Farm follows most of the school codes, some of which includes no short-shorts, bare bellies or backs, muscle shirts or spaghetti straps. Junior Counselors will be assisting Senior Counselors in supervising camp activities such as archery, horseback riding, fishing, cable swings, canoeing, animal care and other camp activities.

Junior Counselors serve one week on a voluntary basis and will be given a certificate of community service hours.  They will need to bring a sack lunch and drinks will be provided. We look forward to having a great summer at Family Farm.

 

Name_______________________________Age____ Birthday_____________________

 

Address ______________________________ City__________ State___ Zip__________

 

Home Phone # __________________ Other # _________________ Email_____________

 

Father’s Name ____________________Work Place____________ PH.# _____________

 

Mother’s Name ____________________Work Place____________ PH.# ____________

 

Physician’s Name ____________________________ PH#_________________________

Please list any additional information, Ex. Allergies, asthma, present medication, etc.

______________________________________________________________________

Have you attended any Family Farm camps before? As camper_____ As jr. counselor______ 

Which Camp do you want to work? Designate 1st choice and 2nd choice.

Camp 1 June 8-11_______ Camp 2 June 15-18 _______Camp 3 June 22-25_______

Camp 4 June 29-July 2_______Camp 5 July 6-9 _______ Camp 6 July 13-16_______

Camp 7 July 20-23_______ Camp 8 July 27-30_______

As the parent or Guardian of Name ________________________, I give my permission for he/she to serve as a Junior Counselor at Family Farm. I hereby request and give consent to the directors of Family Farm or duly appointed representative, for my child to receive such medical or surgical aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in case of an emergency, when the parents cannot be reached. I also give my consent for Family Farm to take my child on designated field trips or to transport in emergencies. My child has permission to participate in activities such as horseback riding, archery, riflery, fishing, riding cable swings, games, creek activities, canoeing, and other activities that the camp directors feel is safe and supervised. I release Family Farm, their owners, successors, and any employee(s) from any and all liability for loss, damage, injury, death, illness, or any other claim now and forever regarding the participation in any activities associated with Family Farm for myself, my children, and wards.

 

Parent or Guardian Signature,  _____________________________ Please include three references other than family.

Reference Name

Reference Phone Number

1.

 

2.

 

3.