CAMP DE BENNEVILLE PINES

APPLICATION

Name:________________________________
Email:________________________________
Kjaeschwartz@gmail.com
Kara Schwartz
717 Rosarita Drive , Fulllerton,
California,
92835
Address:_____________________________________________________________________

(Street)
879-7896
Phone: (_____)
714 _________________

(City)

(State)

(Zip)

Cell# (____)
______________________
714 322-6887

Date of Birth: ______________________________________________
December
, 21,
19996
(Month)

(Day)

(Year)

Parents or Guardians: __________________________________________________________
Kim and Peter Schwartz
Education:
Orange County High School of the Arts
School attending: _______________________________
Class in fall: ____________________
Bridges Academy
Experience in Clubs and Other Organizations:
Name of Organization
Years as Member
Science Olympiad
1
1. _______________________________
__________
Bridges creative writing club
2. _______________________________
__________
3
3. _______________________________
__________
Camp Experiences:
Name of Camp
Camp Debeniville Pines
1. ___________________________
2. ___________________________
Camp James
3. ___________________________

Location
______________
______________
______________

Years as Leader/Assistant
__________
__________
__________
Years as Organization/Camper
_________
6
_________
_________

Other Related Leadership or Work Experience:
Leadership Courses: ____________________________________________________________
Leadership Experiences: _________________________________________________________
_______________________________________________________________________________________
_____________________________________________________________________
For the year of 2012 I worked at my Karate dojo as a sensei in training
Work/Volunteer Experiences: _____________________________________________________
often working with little kids and teaching them how to do karate.
_______________________________________________________________________________________
_______________________________________________________________________________________
____________________________________________________________
Certifications:
Provide date & location certified. Indicate level achieved. Note certifying organization (ARC, YMCA, BSA, etc.).
Swimming:
__________________________
Certified in CPR at camp Debeniville as part of CIT training
First Aid:
__________________________
Outdoor living skills:
__________________________
Other training/certifications:
__________________________

***As part of the Application process you will need to forward the reference form
To your references, one of which is your DRE or Minister.***

Sign up to vote on this title
UsefulNot useful