Camp Counselors USA
A Special Placement Request Addendum
CCUSA :
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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
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