Date:
Name:  Name Called:

Permanent address:  
City:   State: Zip:
Phone:     E-mail:

Current address:  
City:   State: Zip:
Phone:    E-mail:

Church Preference Age:   Date of Birth: Month Jan Feb Mar April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970
Height Weight Marital Status Single Married Divorced      Spouse's name:
Names and ages of children
Names and ages of brothers/sisters? 
What are/were your parents' occupations?
Parents' names    Home address:
City:   State: Zip: Phone:

EDUCATION STATUS
School: 1 2 3 4 5 6 7 8 9 10 11 12 College 1 2 3 4 5 6+
Previous schools (degrees), dates:
Major:   Minor:GPA:  
Comments:
Honors and affiliations (academic, sorority, athletic, military):


What career do you plan to follow:

 EXPERIENCE AS A CAMPER
Camp                                        Director                                 Address                                                          Dates




JOBS HELD (most recent first):
    Position                        Business or Camp             Supervisor or Director          Address                                Phone           Dates
1.
  
2.
  
3.
  
Citizen of: Social Security #

TRAINING AND COUNSELOR PREFERENCE: Please check

  



WATER SPORTS
Red Cross GuardStart (list programs)
Red Cross Lifeguard Training: (expires )  Basic Water Rescue
CPR 9which type?) (expires )  1st Aid (which type?)  (expires )
Lifeguard Instructor Trainer (expires )
Safety Training for Swim Coaches (expires )
Competitive swimming   Synchronized swimming
Competitive diving Water Polo
Other water sports (explain)
Canoeing: Certified Red Cross 0 X XX XXX XXXX Instructor Certification
Fishing 0 X XX XXX XXXX Casting 0 X XX XXX XXXX Fly 0 X XX XXX XXXX Experience


HORSES
English Riding  0 X XX XXX XXXX Hunt Seat 0 X XX XXX XXXX Jumping 0 X XX XXX XXXX
Show experience
Western Riding: 0 X XX XXX XXXX Western Pleasure 0 X XX XXX XXXX Rodeo 0 X XX XXX XXXX
Care and Feeding 0 X XX XXX XXXX   Horseshoeing 0 X XX XXX XXXX
Other Horseback experience


SPORTS
Basketball 0 X XX XXX XXXX Softball 0 X XX XXX XXXX Tennis 0 X XX XXX XXXX Golf 0 X XX XXX XXXX Soccer 0 X XX XXX XXXX Volleyball 0 X XX XXX XXXX
 Track 0 X XX XXX XXXX Lacrosse 0 X XX XXX XXXX Other Field Sports (specify)
Tumbling 0 X XX XXX XXXX Floor Exercise 0 X XX XXX XXXX Gymnastics 0 X XX XXX XXXX Beam 0 X XX XXX XXXX Fencing 0 X XX XXX XXXX
Table tennis 0 X XX XXX XXXX Badminton 0 X XX XXX XXXX Cheerleading 0 X XX XXX XXXX Drill team 0 X XX XXX XXXX Flag team 0 X XX XXX XXXX    
Twirling 0 X XX XXX XXXX
High school&/or college athletic experience

 ARCHERY
Certification? 0 X XX XXX XXXX Target 0 X XX XXX XXXX Bow hunting 0 X XX XXX XXXX Bow fishing 0 X XX XXX XXXX

 RIFLERY
Certified NRA Instructor Date   Skeet
Certified NRA AssistantDate
Other rifle certification

ARTS and CRAFTS
Ceramics 0 X XX XXX XXXX Leather 0 X XX XXX XXXX Wood 0 X XX XXX XXXX Sketching 0 X XX XXX XXXX Painting 0 X XX XXX XXXX  
Metal 0 X XX XXX XXXX Batik 0 X XX XXX XXXX Weaving 0 X XX XXX XXXX   Needlework 0 X XX XXX XXXX Calligraphy 0 X XX XXX XXXX
Crafts 0 X XX XXX XXXX Others:

FINE ARTS
Choral (Part you sing) Instruments (specify)
Drama 0 X XX XXX XXXX Skits 0 X XX XXX XXXX Production 0 X XX XXX XXXX Scenery 0 X XX XXX XXXX Creative 0 X XX XXX XXXX  
Puppetry 0 X XX XXX XXXX Sign language 0 X XX XXX XXXX
Photography: Still 0 X XX XXX XXXX Dark room 0 X XX XXX XXXX Movie 0 X XX XXX XXXX Video 0 X XX XXX XXXX
Dance: Jazz 0 X XX XXX XXXX Ballet 0 X XX XXX XXXX Aerobic 0 X XX XXX XXXX Folk 0 X XX XXX XXXX Tap 0 X XX XXX XXXX


CAMPCRAFT
Hiking 0 X XX XXX XXXX Cooking 0 X XX XXX XXXX Nature Study 0 X XX XXX XXXX Scouting (Rank)
Certified American Camping Assn. Instructor?
Fishing 0 X XX XXX XXXX Other

ADVENTURE ACTIVITIES:
 Initiatives 0 X XX XXX XXXX Low elements 0 X XX XXX XXXX High ropes elements 0 X XX XXX XXXX Ropes course training  0 X XX XXX XXXX Rappelling 0 X XX XXX XXXX
Climbing 0 X XX XXX XXXX


INDIAN LORE
Dancing 0 X XX XXX XXXX Storytelling 0 X XX XXX XXXX Costume making 0 X XX XXX XXXX   Other


Any other instructor certifications

WHAT WOULD BE YOUR PREFERENCE OF ACTIVITIES TO TEACH:
1st    2nd     3rd

Describe your background experiences and training in your preferred teaching area

CAN YOU? (Yes or No):
Keep books Manage camp store Plan & lead campfires Conduct vespers & chapel
Lead sing songs Edit camp paper/yearbook
In which computer programs are you proficient?
 

WHAT AGE CAMPER WOULD YOU PREFER IN YOUR CABIN?
6-8 9-10 11-12 13-16 No preference

CHECK TERMS YOU WISH TO BE EMPLOYED:
First Term Second Term Third Term   As Needed

NOTE: Most counselors work two or more terms, although there are occasionally a few places available for one-term employment. COUNSELOR ORIENTATION stars two weeks before campers arrive; all counselors are expected to attend this orientation. Employment will extend two days beyond the campers' Closing Day.


REFERENCES: List five non-relatives who know you and your abilities. Phone number is important. Attach a sheet of paper if necessary.
 NAME                    OCCUPATION                  ADDRESS                              TELEPHONE                          E-MAIL






How did you hear about The Heart?
Assuming mutual satisfaction, would you be avaiable for several summers? Estimated number of summers
 Do you have Valid Driver’s License? (type) State issued Driver’s License #
Number of accidents, tickets, received in the last three yeears:


(please specify date and place received, i.e. Feb 1, 2007, Kerr County, or City of Kerrville, and type of ticket.)

I certify the above five pages of information to be correct.

__________________________________________________________
Signature

NOTE: Heart staff members must be able to observe, participate with, and safely
supervise all camp activities, including rough terrain rescue. Staff members must be
able to communicate well, for purposes of instruction, safely, and written reports.
Female staff members live in camp cabins with girls 6-16. Counselors must conform
 to arbitrary standards of appearance, including restrictions on visible body piercings.


We at "The Heart believe that if your goals and our goals are closely aligned, you will be a happier counselor, and we will have a happier camp. Please answer the following frankly and thoughtfully.

Why do you want to serve as a Heart counselor?


Development of a camper's character is an important goal at The Heart. In what way do you feel you can contribute as a role model?


In your opinion, what should camp provide toward the religious development of a camper?

Toward her patriotic development?

What emphasis do you think should be given to rules and discipline in a camp setting? 1) to campers 2) to counselors

What policies do you think a camp should set for counselors regarding alcohol use during free time off camp? Tobacco?

                                               Please print and mail or fax the the numbers above.