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Junior Counselor Application Form 2023
Please complete all of the required fields before submitting your application. If any of the fields do not apply to you simply type "NA" or "Not Applicable" in the box. If you have any questions or comments about the application form, please contact Anna "Pearl" Reineke at
pearl@walcamp.org
.
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* Indicates required question
Email
*
Your email
General Information
First Name
*
Your answer
Last Name
*
Your answer
Camp Nickname (if you served as a JC previously)
Your answer
Address 1
*
Your answer
Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip/Postal Code
*
Your answer
Primary Email (This will be the MAIN way that Walcamp Outdoor Ministry will communicate important information with you, so please make sure it is an email address you check often.)
*
Your answer
Phone number
*
Your answer
Current Grade
*
Choose
9th
10th
11th
12th
Year of High School Graduation
*
Your answer
Parent #1 (Primary Contact)
Please enter contact information below for the parent who is your primary contact.
Name (First & Last Name)
*
Your answer
Cell Phone Number
*
Your answer
Home Phone Number
*
Your answer
Email
*
Your answer
Address 1
*
Your answer
Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip/Postal Code
*
Your answer
Parent #2 (Secondary Contact)
Please enter contact information below for the parent who is your secondary contact.
Name (First & Last)
Your answer
Cell Phone Number
Your answer
Home Phone Number
Your answer
Email
Your answer
Address 1
Your answer
Address 2
Your answer
City
Your answer
State
Your answer
Zip/Postal Code
Your answer
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