Camp Darom

Camp Darom 2009 Staff Assistant Request Form

( For teenagers entering grades 9-10 in fall 2009)

Your Name

Date of Birth

Male Female

Address

City

State

Zip Code

Phone Number

Email

Grade entering in Fall 2005

Educational History Please list all schools you have attended
Name	Location	Dates	Special notes (honors etc)

Camp History Please lest all camps you have attended
Name	Position	Dates	Day camp or over night

List other work experience

References - Please list two people we can contact