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Camp Geiger Staff in Training Application Pony Express Council Boy Scouts of America Full Name Street Address Will you be at least 14 by June 1 of this year Yes No Email City State Phone Zip Code Cell Name phone of person to contact in case of emergency School Attended Grade If employed list Employer s name Current Registration Job/Position Current Rank Troop Crew Council Name of Unit Leader Years at Geiger Member of Mic-O-Say Name High Adventure Experience Other Camps Tribal Rank and Name Please provide references must list 2 Can you commit to an entire 3-week program If No please list any conflicts Do you have a preference of program sessions Sessions 1-3 No Preference Have you ever been convicted of a felony or misdemeanor not including traffic violations Yes Are you on probation You may answer No if your conviction has been ordered sealed expunged or eradicated. Conviction is NOT an automatic bar to the program. All circumstances are considered including the specific crime and when it occurred. If you answer Yes please provide complete information by attaching a separate statement. Is there anything Camp Geiger or the Pony Express Council should know that makes you unsuitable to work children If you answered Yes please provide complete information by attaching a separate statement. Turn the page over and complete. Please personally fill out the following questions by hand What would you say are your Strengths Weaknesses What do you expect to gain from the GSIT program How can a member of the Camp Geiger Staff help change the life of a camper Describe something you have done in the past year that you are proud of* Signatures Below Applicant On My Honor the information on this form is correct. Parent or Guardian Mail this completed application to GSIT Director P. O. Box 8157 St* Joseph MO 64508 Date. Is there anything Camp Geiger or the Pony Express Council should know that makes you unsuitable to work children If you answered Yes please provide complete information by attaching a separate statement. Turn the page over and complete. Please personally fill out the following questions by hand What would you say are your Strengths Weaknesses What do you expect to gain from the GSIT program How can a member of the Camp Geiger Staff help change the life of a camper Describe something you have done in the past year that you are proud of* Signatures Below Applicant On My Honor the information on this form is correct. Turn the page over and complete. Please personally fill out the following questions by hand What would you say are your Strengths Weaknesses What do you expect to gain from the GSIT program How can a member of the Camp Geiger Staff help change the life of a camper Describe something you have done in the past year that you are proud of* Signatures Below Applicant On My Honor the information on this form is correct. Parent or Guardian Mail this completed application to GSIT Director P. O. Box 8157 St* Joseph MO 64508 Date. Is there anything Camp Geiger or the Pony Express Council should know that makes you unsuitable to work children If you answered Yes please provide complete information by attaching a separate statement. Turn the page over and complete. Please personally fill out the following questions by hand What would you say are your Strengths Weaknesses What do you expect to gain from the GSIT program How can a member of the Camp Geiger Staff help change the life of a camper Describe something you have done in the past year that you are proud of* Signatures Below Applicant On My Honor the information on this form is correct. Parent or Guardian Mail this completed application to GSIT Director P. O. Box 8157 St* Joseph MO 64508 Date.

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