This Harleysville Summer Day Camp does not discriminate in hiring on basis of race, color, religion, sex, national origin, disability, veteran status, or your
membership in any protected class protected under law of this jurisdiction. This application does not intend to ask questions that would provide information
that could be used for discrimination. Your application will be given the consideration it deserves; however, completing the application
does not imply that you will be offered employment.
2024 Harleysville Summer Day Camp Application
Please attach your resume or work history including team affiliations, clubs, organizations or
awards/honors you have achieved.
Name:________________________________ _____________________________ _____ M F
Last First MI Sex (Circle)
Address:________________________________________________________________
______________________________________________ ______ ____________
Town/City State Zip
Phone:______________________________________ ____________________________________
Home Work
_____________________________________________ ____________________________________
Cell Email
Date Of Birth:________________________ HS/University Currently Attending_____________________________
Course of Study (College or HS) or considering ___________________
Projected Graduation Date/Yr. ________________________________
Township in which you reside: _______________________________________
Position applying for (Note: Senior Counselors and Special Instructors must be HS Graduate this year or beyond.)
____ Junior Counselor ____ Senior Counselor _____ Lifeguard ____ Special Instructor
If Jr. Counselor: _____ Age ______ Grade completed this school year
Please check off the weeks that you are committing to work. If partial weeks due to school ending late, please write down the
exact dates that you can work that particular week. A minimum seven-week commitment is recommended for consideration
of employment.
Week of:
___ 6/17 ___ 6/24 ___ 7/1 ___ 7/8 ___ 7/15 ___ 7/22 ___ 7/29 ___ 8/5
Camp not is session Thursday, July 4
Your completion of these forms helps us to adequately staff the Harleysville Summer Day Camp. It does not guarantee nor
constitute a contract of employment.
Mail or email (preferred) completed application and resume (preferred) to:
Harleysville Summer Day Camp
P.O. Box 480
Harleysville, PA 19438-9998
Contact Joe Kilpatrick, Camp Director at [email protected] for questions.
For Office Use Only (Do not write in this box)
Date of Hire: ___________________ Pay Rate: ________________ Employee #: ____________________
