NOTE: Confidential Reference Form
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Heart staff members must be able to observe, participate with & safely supervise all camp activities, including rough terrain rescue. Female staff members must line in cabins with girls 6-16. Staff members must be able to communicate well for instruction, safety, and parent reports.

Heart O' the Hills Camp
for Girls

C. Jane Ragsdale, director
2430 Highway 39
Hunt, TX 78024-3410
830-238-4650  Fax 830-238-4067
www.hohcamp.com, info@hohcamp.com
 

CONFIDENTIAL REFERENCE FORM

____________________________ has made application to  Heart O' the Hills for a position as a staff member / counselor.

We would like your confidential appraisal of the applicant. Please mail directly to Jane Ragsdale, Heart O' the Hills Camp, 2430 Highway 39, Hunt, TX 78024-3410.

Please rank attributes below:

Superior
(Best ever seen or ever hope to see)
Excellent Good Satisfactory Not Satisfactory No Basis for Judgment
First Impression            
Personal Appearance            
Likeability            
Sense of humor            
Sense of self-worth            
Self-control            
Attention to detail            
Flexibility            
Ability to teach            
Ability to plan & organize            
Talent working with children            
Ability to cooperate            
Willingness to serve            

How long have you known the applicant _________________In what relationship?________________________
When was the last time you had personal contact with her?___________________________________________
Is there any reason to check additionally on this applicant? __________________________________________
Does applicant have physical/mental problems/disabilities we should be aware of? _______________________
Should we check additionally on this applicant? ____________________________________________________
Does applicant have any physical/ mental problems or disabilities we should know about? _________________
Would the applicant be a good leader with girls?____________________________________________________
If you had a camp-age daughter, would you be pleased to have applicant as her counselor?_________________
Remarks:____________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Signed: __________________________________ Print Name:________________________________________
Official Position: _____________________Telephone : (___)_____________ email:________________________
Mailing Address: ______________________________City:__________________ State: _____ Zip: __________
If you would rather give an evaluation over the phone, please check here and we will call you. _______
Would you like information on Heart O' the Hills for Girls? ____ Girl(s) Name(s) & Age(s)__________________________
                                    Camp Stewart for Boys? ____
Boy(s) Name(s) & Age(s)_____________________________