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PROGRAM DESCRIPTION This summer, the Kroc Adventures Day Camp program is launching a Jr. Counselor program for young people ages 12 – 14. This program will involve giving young people ages 12-14 hands on leadership experience while also giving them structured activities during the summer in a fun, safe environment. Accepted applicants will be placed with a counselor to assist the counselor in supervision of a group of children as well as to help plan and execute activities. Applicants will need to demonstrate an acceptable level of maturity in line with the mission of the day camp and the supervision of children. Below please find all the finer details as well as the application form which needs to be completed and returned to The Salvation Army. Applicants will be reviewed on a first come, first served basis. ELIGIBILITY  Must be between the ages of 12 – 14  Completed the 6th Grade  Parent/guardian permission  Complete the application  1 Reference from a teacher (form attached)  Demonstrate an acceptable level of maturity SESSIONS Jr. Counselors will be accepted on a two week session basis. Please indicate and rank your preferred session on the application form. Session preference will be determined on a first come, first serve basis. Applicants may apply for additional sessions, however these be will subject to availability. FEES & HOURS The cost for each two week session is $80 ($40 per week). This includes lunch, supervision from 8:30AM – 4:00PM and all field trips (except the Michigan Adventures on Aug 6) and activities. SUPERVISION Supervision will be given by a Day Camp Counselor. Jr. Counselor will be asked to report each day by 8:45AM and stay until at least 3:30PM. CODE OF CONDUCT The Jr. Counselor Program has been developed to not only provide a meaningful leadership opportunity to young people, but also assist our camp counselors and the overall operation of the day camp. For this reason, if it any time the Jr. Counselor fails to meet a reasonable level of expectation and/or does anything to compromise the successful operation of the day camp, The Salvation Army reserves the right to dismiss the Jr. Counselor from the program without refund. ADDITIONAL INFORMATION Once accepted, all parents/guardians of Jr. Counselors will need to complete a medical form and sign the camper responsibilities. This must also be accompanied by a signed ‘parent’s responsibilities’ form. All of these forms are contained in the regular Day Camp Application. NOTIFICATION Upon the successful completion and receiving back of all forms and a $25 deposit (this includes the teacher evaluation), we will notify you promptly of our decision of acceptance into the program.

If you have any questions, please feel free to call the Kroc Transitional Center at 616.241.3723.


REGISTRATION FORM (COMPLETE ONE FOR EACH TWO WEEK SESSION) Camper’s Name: __________________________________________

Date of Birth: _____________ Age:  12  13  14

Parent(s) Name(s): ______________________________________________________________________________ Camper Lives with (custodial parent): _________________________________________ Home #: _________________________ Work #: _________________________ Cell #: ________________________ Address: __________________________________________ City: _____________ State: ___________ Zip: ________ Parent Email: ________________________________________________ Camper’s School: ____________________________ T-Shirts:

 Youth S  Youth M  Youth L  Adult S  Adult M  Adult L  Adult XL

TO BE COMPLETED BY THE YOUNG PERSON Why do you want to participate in the Kroc Adventures Jr. Counselor Program?

Tell us a little about yourself – family, school, etc.

Give us an idea of some of the things you are currently involved in, your hobbies and interests:

And finally, describe yourself in only three words……

Session (Please rank in order of preference 1 – 5)

Session Field Trips

____1 & 2 (June 14 – 18) & (June 21 – 25)

John Ball Zoo & Circle Theater

____3 & 4 (June 28 – July 02) & (July 6 – July 9*)

Bowling & White Caps Baseball

____5 & 6 (July 12 – July 16) & (July 19 – July 23)

Roller skating & AJ’s Fun Park

____7 & 8 (July 26 – July 30) & (August 2 – August 5)**

Children’s Museum & Bounce Party

* In observance of July 4th, we will not be holding camp on July 5th. ** A Michigan Adventure Field Trip will be held on August 06 for an additional fee of $30.00 per participant. Please note that we will not be holding camp this day for those who do not come. *** Jr. Counselors are brought on in two week increments. 4 spots are available every two weeks and are evaluated on a first come, first serve basis. Applicants may apply for additional weeks, however placement is not guaranteed. Upon the successful completion and receiving back of all forms (this includes the teacher evaluation), and a $25 deposit we will notify you promptly of our decision of acceptance into the program.

Please complete reverse side


PAYMENT AND REFUND POLICY A $25 dollar non-refundable deposit is due upon pre-registration for the two week session. The balance of fees for the session reserved is due 1 (one) week prior to the reserved week. Failure to pay by this time will result in a forfeit of the deposit and registration. Enrollment may be re-instated based on space availability; however a $10 late fee will be added to the balance due. Space is limited; registrations will be accepted on a first-come, first served basis. Deposits may not be transferred to a future session. Refunds will be given for applicants not accepted into the Jr. Counselor program otherwise no refunds are given unless the program is cancelled by the Transitional Kroc Center. Please charge my:

 Visa  Mastercard  Dicover

Account# __________________________

 Charge entire balance  Charge non-refundable balance only

Signature: ________________________ Expiration Date: ____________

ACKNOWLEDGEMENT OF GRAND RAPIDS RJKCCC DAY CAMP BEHAVIORAL POLICIES/PHOTO RELEASE Camper safety is our top priority. Campers are expected to follow the peace contract by keeping hands and feet to themselves, listening to all instructions and staying with the group. I understand that if my child does not adhere to these expectations disciplinary consequences will occur. Repeat or more serious acts such as fighting, theft and possession of weapons/drugs will result in immediate suspension or expulsion, necessitating removal from the camp. I or an authorized adult is responsible for picking him/her up immediately. Parent/Guardian Signature: ______________________________________________

Date: ________________

I have answered all the questions as fully and honestly as possible and wish to be considered for a place as a Jr. Counselor for this summer’s Kroc Adventures Day Camp. ___________________________________________ JR. COUNSELOR APPLICANT SIGNATURE

_________________________ DATE

I support this young person’s application for a place as a Jr. Counselor for this summer’s Kroc Adventures Day Camp. ___________________________________________ PARENT/GUARDIAN SIGNATURE

_________________________ DATE

The Jr. Counselor application along with a deposit of $25, should be submitted to the attention of: Day Camp Director, 1632 Linden Ave. SE, Grand Rapids, MI 49507. Alternatively, they may be dropped off at this location M – F 8:30AM – 4:30PM. Successful applicants will also need to fill out a Medical Release Form and a Parent/Child Responsibilities Form. These will be mailed to the applicants upon acceptance.


To be completed by one of the applicants teachers. CONFIDENTIAL Instructions: The following student is applying to be a Jr. Counselor for The Salvation Army’s Kroc Adventures Day Camp this summer. To help us decide on the acceptance of this individual, please fill out the information below. When completed, please either mail to The Salvation Army, Attention: Program Director 1632 Linden Ave, SE, Grand Rapids, MI 49507 or fax to 616.241.5777. If you have any questions, please call 616.241.3723. Thank you! Students Name:

_____________________________________________

Teacher’s Name:

_____________________________________________

How do you know this individual?

Please rate the student on the following. 1 being the lowest and 5 being the highest. Leadership

1

2

3

4

5

Creativity

1

2

3

4

5

Responsibility

1

2

3

4

5

Helpfulness

1

2

3

4

5

Decision Making

1

2

3

4

5

Please indicate your feelings on this student working with children.

Any other comments?

Signed_____________________________ Telephone#__________________________

Date____________________

2010 DAY CAMP JR. COUNSELOR APPLICATION  

Below please find all the finer details as well as the application form which needs to be completed and returned to The Salvation Army. Appl...