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Camp Counselors USA A Special Placement Request Addendum CCUSA : jqnemetvenen cousaes Anu Etlen_Zagaso Sdn cheZ cousa oe MAL [2] [2 [9] 1 request the following placement from CCUSA {check one box: 1. Placement at a specific camp, camp Name — —__—— ate Name of preon Ive been in contact wth Empoyment flr receved, C1YES LINO Contract signed Ces CIN ] 2 Placed with another participant ke phonic fous Copeliig omer Partepant ine AX 12130 faatorshpto met Unweiesty fend Ymyyouwedd hetobe paced toneter I wal UE KS OVE Ina comp o« Mtn haw emu we nae 40 Oth olka coaybn ee Wel beng fool SS gee LO Know now cultures ard Lenguage) While wavelingy — they hove fHeree Cold vs crocus expenecel 86 Some ErtendS Who aie alredy fi dpa tea ong: (& weld seem co us thoy Port 4 would umprowe Lhe ex per'e while Lo wo Je of ove working 404% {her, opate from brow woylo o Komencra help vs 40 be mC conc a at CCUSA cannot guarantee a1 unt rd zat my paconet CONEK dan AAO OLY anys ves not cancel fo the program | do cance, |v erlet a ees pad io CCUSA foes not the above eques ‘Sgrature a Ni 8 —________ bate 13-Oa - ga

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