Arlene Streisand's Summer Camp Services Application
P.O. Box 196, Jericho, NY 11753
1-800-443-6428 • • • 516-433-8033 • • •Fax: 516-933-7949

Two references are required
Note- There are some areas in the application below where scrolling may be necessary

If you have trouble transmitting your form online please print and
fax to: 516-933-7949 or visit our printable form here.

(whom reference is for)
Who has applied to us for the position of:

Since we wish to engage people with proven ability and emotional stability, we would greatly appreciate your frank opinion. If you do not know the applicant in a camp setting, answer the questions below from your own frame of reference. We wish to thank you for your kind cooperation and assure you that your information will be held in the strictest confidence.
(Please follow the scale 1 being superior and 6 being poor)
Ability to teach above listed skill
Warmth and liking to children
Understanding of needs of children
Ability to be fair - not partial
Imagination and enthusiasm
Ability to get along with people
Health, energy and endurance
Ability to accept responsibility
Adaptibility to structure
Willingness to learn
Reaction of people to applicant
Personal appearance
Maturity compared to peers

To the best of your knowledge has the applicant ever been investigated for allegations of child abuse?

Yes No - additional comment
To the best of your knowledge has the applicant ever been convicted of a felony or misdemeanor which resulted in imprisonment?
Yes No - additional comment
How do you know applicant?  
Your Name:  
Additional Comments:
(additional comments wil be very helpful)
This reference form should be completed by a former employer, coach, teacher or other professional, NOT be a roommate, friend, neighbor, etc.


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