Camp Towanda : Staff Reference Form

Applicants Name: (Required)
Position Applying For:

Ability to teach above listed skill:
Warmth and liking for children:
Understanding the needs of children:
Ability to be fair -- not partial:
Imagination and enthusiasm:
Ability to get along with others:
Health, energy and endurance:
Ability to accept responsibility:
Willingness to learn:
Leadership skills:
Personal appearance:
Maturity compared to peers:
Motivation:
Tolerance of others:
Will be a good Role Model for Children:
Ability to cope with Rules, Regulations & Restrictions (smoking, alcohol, curfew…):
In summarizing this applicant the following best describes him/her:

To the best of your knowledge has the applicant ever been investigated for allegations of child abuse? Yes No

To the best of your knowledge has the applicant ever been convicted of a felony? Yes No

Is there any reason you are aware of that this person should not work with children? Yes No

If yes, please explain:

Would you have any hesitation in allowing this applicant to be in a living situation (24 hr/day) with your or anyone’s children? Yes No

If yes, please explain:

Please express any other comments regarding the applicant that you feel appropriate:

How do you know the applicant:
Your Name: (Required)
Position: (Required)
Company: (Required)
Email Address: (Required)
Phone: (Required)

Please enter the 5 digit security code shown above:

Camp Towanda • 700 Niles Pond Road, Honesdale PA 18431 For Boys & Girls • Nestled in Northeastern Pennsylvania's Pocono Mountains Winter • Phone: 845-639-4582 \| Summer • Phone: 570-253-3266
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