Assistant Director Camp Application

Name(required)

Email(required)

Date of Birth (Year/Month/Date)(required)

Address(required)

Postal Code(required)

City(required)

Parent/Guardian 1 (if under 18yrs)(required)

Parent/Guardian 2

Email 1 (if under 18yrs)(required)

Email 2

Phone 1 (if under 18yrs)(required)

Phone 2

OHIP #(required)

Emergency Contact (Name)(required)

Emergency Contact (Phone #)(required)

Have you ever suffered from asthma, heart problems, breathing problems or any other medical condition that may affect your ability to participate in this program?(required)

Are you on any medication that we need to know about?(required)

Do you have any allergies? Please specify.(required)

Do you have any alternative accommodations needed to perform in this role? Please specify.(required)

How many summers have you been a senior counsellor?(required)

1 2 3 4+

Why are you interested in this position?(required)

What other leadership roles have you had that would prepare you for this position?(required)

What qualities could you bring to this position?(required)

What do you think would be challenging for you in this position?(required)

Are you able to commit at least 2 summers to this position?(required)

Yes No

Please check all the sessions you are available for:(required)

July 5-16: Funkytown July 19-30: Winter Wonderland August 9-20: Ghost Busters August 23-27: Medieval Times

Injury Waiver: Each student and his or her legal guardian(s) hereby release Milton Youth Theatre Productions and Directors, Teachers and Employees from claim for personal injury sustained in, on or about the facilities.(required)

Photography & Video Waiver: Each student and his or her legal guardian(s) hereby release Milton Youth Theatre Productions the rights to all photography and video that may be taken by or for Milton Youth Theatre Productions during classes or performances, for use in advertising and promotion, including television coverage.(required)