1). First Name
*
2). Last Name
*
3). Email
*
4). Phone
*
5). Address
*
6). State
*
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Lousiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
7). Zip
*
8). D.O.B.
*
9). List Extracurricular Activities, Honors, and Hobbies.
*
10). Summer camp work involves close contact with children. Have you ever been investigated, arrested, or convicted of Child Abuse, Neglect, or Related Charges?
*
Select
Yes
No
11). Drug or Alcohol Charges?
*
Select
Yes
No
12). Have you ever been convicted of any other criminal activity?
*
Select
Yes
No
12 b). If yes, please explain.
12 b). If yes, please explain.
13). List camp-related or other education related activities in which you have expertise.
*
14). Write a brief explanation of why you would be a good fit as a volunteer summer camp counselor at MDWFP’s Mississippi Museum of Natural Science.
*
15). Please select all camps that you would be available to work.
Select all that apply:
Week 1: May 27-30 Kintergarten - 1st/2nd Grades
Select
Yes
No
Week 2: June 2-5 Kindergarten
Select
Yes
No
Week 3: June 9-12 PreK
Select
Yes
No
Week 4: June 16-19 3rd/4th Grades
Select
Yes
No
Week 5: June 23-26 5th/6th Grades
Select
Yes
No
Week 6: July 7-11 Spanish Camp - 1st/2nd Grades
Select
Yes
No
Week 7: July 14-18 Mad Scientist Camp - 3rd/4th Grades
Select
Yes
No
Clear