Counselor Regisration Form

Please fill the details below to REGISTER as a Counselor

Section 1 : Personal Information

First name

Last name

Birthday

Day

Month

Year

Education

Phone Number

Address

Section 2 : Experience & Background

What motivates you to apply for this Counselor Role?

List prior experiences where you had to engage, lead or manage children. (Examples : School clubs, tutoring, volunteering, summer camps, etc)

Are you able to attend training, create content and lead campers?

Yes

Section 3 : Health & Insurance Agreement

Once selected, please submit within 3 weeks:

1. Health insurance card (both sides)

2. Immunization Record

3. Covid-19 Vaccination

4. Physician statement of physical ability

Email: dharmaawakeningfoundation@gmail.com

Mail: Dharma Awakening LLC, 2 Long Ridge Court, Unionville CT - 06085

Yes, I agree to this requirement.

Confirm

Section 4 : Attendance Acknowledgement

The applicant has read the Rules & Regulations of Camp and will adhere.

Camp runs Sunday to Friday. Full attendance is mandatory. No special accommodations/foods will be provided. The applicant must be fit to participate and agrees to use of photos/videos for promotional purposes.

Applicant takes full responsibility and releases Dharma Awakening LLC from liability.

Yes