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Staff Enrollment Application
Summer 2023/5783 July 22 - August 15
If you are currently in 12th grade, please use the 12th Grade BM Application. There will be an option to choose if you are coming to camp as a Camper or Junior Staff member.
Please note that the application cannot be saved in progress and that the following items will be required in order to submit your application:
Copy of Insurance Cards
Immunization Records
Income Information for lunch form (Only required for applicants younger than 19 as of July 1st.)
Paperwork
Please upload the following documents before completing the application:
Immunization Records, Front and Back Copies of Insurance Cards, Completed Lunch Form
Immunization Records
Choose file
Immunization Record Additional Page (if applicable)
Choose file
Insurance Name
Name on Card
Insurance ID #
Insurance Card Front
Choose file
Insurance Card Back
Choose file
Staff Application Form
Last Name
First Name
Date of Birth
Age
--Select--
17
18
19
20
21
22
Address
City
State
Zip
Country (if outside USA)
Home #
Cell #
Best number for text updates (this is required)
Yeshiva
Yeshiva Address
City
State
Zip
A contact # for you to be reached at in Yeshiva
Best time to be reached
Position Applying For:
2nd Preference
Lunch Form (Required for boys 18 and under)
A summer feeder form is required for every camper in Ruach Chaim, EVEN IF YOU ARE NOT ELIGIBLE FOR FREE MEALS. Please send in a separate form for each applicant.
  - If you do not meet the income eligibility guidelines, please fill out your name, write “not eligible”, and sign the form.
  - If you are eligible for free meals, please complete the form as follows:
Part 1. Fill in the name of CRC applicant only.
Part 2. If applicable, fill in your SNAP (Food Stamp), TANF or FDPIR case # and skip part 3.
Part 3. List ALL household members, not only the ones with income. Please list total income for each household member, and write 0 or leave blank for those with no income.
Part 4. Signature and social security are required despite eligibility.
Download Form
Download
Upload Completed Form Here
Choose file
Additional Form?
Form 2
Choose file
Family Information
Father's Title
--Select--
Rabbi
Mr.
Dr.
Father's Name
Occupation
Cell Number
Email
Mother's Title
--Select--
Mrs.
Ms.
Dr.
Mother's Name
Occupation
Cell Number
Email
Maiden Name
Marital Status
--Select--
Married
Widowed
Divorced
Separated
Shul Family Attends
Rav
Are any members of your family currently registered Camp Ruach Chaim?
--Select--
Yes
No
Who?
Medical Information Form
Physician
Phone #
This medical information form is to be completed by a parent. It is not necessary to have a Physician sign this form. All of the information on this form is kept strictly confidential. We respectfully request that no information be withheld from the camp. You are more than welcome to put a note asking that the appropriate people reach out to you to discuss sensitive information.
Food Allergies
Other Allergies
Activity Limitations
If you come to camp with over-the-counter medications, try to make sure that you have enough for the entire camp season. Some of these unusual over-the-counter meds are not readily available at upstate pharmacies
If you are coming to camp with year-round prescription medication, we must have a note from your doctor detailing the medication prescribed, the dosage, time and frequency it should be taken, as well as the reasons for taking the medication. No unlabeled medication will be dispensed. Verbal information about medication is insufficient. All medication must be kept in the infirmary, even nonprescription ones (ex: benadryl).
Have you ever had an anaphylactic reaction?
--Select--
Yes
No
If yes, you must send an Epi-pen along. (Please make sure that it has not expired or you will be billed for one by the camp.)
If you are being treated for asthma, please send along the tubing for the nebulizer as well as all inhalers being used and make sure the camp is notified.
Emergency Contacts
Name
Phone #
Relationship
Name
Phone #
Relationship
Camp Experience
Number of years attended CRC
Please indicate where you have spent your last few summers:
Av 2022
Av 2021
Av 2020
General Experience
List any abilities, skills, or talents you may have. (Now is not the time to be modest.)
Describe your experience working with children that may be beneficial for you in this job. Give the ages/length of time and what you did with them.
References
Please give two references; i.e., in addition to knowing you well, are in the field of chinuch and have seen you work with children.
Name
Phone #
Affiliation
Name
Phone #
Affiliation
CRC T-shirt/Sweatshirt
Each staff member is entitled to a sweatshirt and t-shirt at no charge. Please indicate the size.
Please select your sweatshirt/t-shirt size.
--Select--
Adult S
Adult M
Adult L
Adult XL
Busing
Please make your selection by placing a check in the appropriate box. Changes to busing can be made up until July 15th, by emailing
[email protected]
To Camp
Lakewood
Monsey
Brooklyn
I will be providing my own transportation
From Camp
Lakewood
Monsey
Brooklyn
I will be providing my own transportation
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