Cognizart 360 Arts Camp Counselor Application (13-18 years old)

Counselor Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Address 1:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Cell Phone:
• * How did you hear about 360 Arts Camp?
• *

  Which week(s) can you commit to being a Counselor?

  • Monday, July 10 through Friday, July 14 at the Newmark Theatre Building
  • Monday, July 17 through Friday, July 21 at the World Forestry Center
  • Monday, July 24 through Friday, July 28 at the World Forestry Center
• * Have you attended our camp before? If yes, please indicate which year(s) you did so.

• * Date of Birth:
• * School:
• * Grade (starting Fall 2021)
• *

  T-Shirt Size:

  • Extra Small
  • Small
  • Medium
  • Large
  • Extra Large
• Will a younger sibling or friend be attending 360 Arts Camp? If yes, please type camper name & age.
• *

  Safety First! You will be required to be fully COVID-19 vaccinated and wear a face-mask and follow and enforce Oregon Health Authority guidelines throughout camp. By checking this box, you agree to do so.

  • I agree
• *

  Are you a former 360 Arts Camper?

  • Yes
  • No

Emergency Contacts

• * Emergency Contact #1 (First & Last):
• * Relation:
• * Cell Phone:
• * Emergency Contact #2 (First & Last):
• * Relation:
• * Cell Phone:
• * Why are you interested in being an Intern at MetroArts Inc. Kids Camp?
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• * What is your favorite arts discipline?
• *

  Which age group do you prefer?

  • Younger - 6-9
  • Older - 10-12
  • Either
• * With the COVID-19 pandemic, if you are under the age of 18, a parent will be required to sign a release. Who should we contact to receive this required release? (Name, relation, phone & email address)

About You

• *

  What pronouns do you identify with?

  • They/them
  • She/her
  • He/him
• * Tell us what makes you uniquely you.