Post Natal Nurse Home Visitor Program
Pharmacy Residency (PGY1)

Camp I-Thonka-Chi Returning Counselor Application

Do you want to return as a counselor at Parkland's Camp I-Thonka-Chi? We'd love to have you again!

Please fill out the form below. To complete this form online, one short document will need to be printed, scanned and submitted near the end of the form.

If you would prefer to fill out the entire form by hand and send it by fax or mail, please see download the Returning Counselor Application PDF.

If you were not previously a counselor, please fill out the New Counselor Application.

Requirements:

  1. Completing and turning in Counselor Application
  2. Participating in an interview process
  3. Attending one volunteer orientation session 
  4. Completing Abuse Prevention Training before due date
  5. Counselor training on camp grounds on June 3
For questions, contact:

Donna Crump - 214-590-2562 | Donna.Crump@phhs.org
- or -
Rosa Garces - 469-419-5533 | Rosa.Garces@phhs.org

Applications are due May 3, 2024


* indicates required field

Returning Counselor Application

* Full Name
* Age
* Sex
Gender
Maiden/Former Legal Name
* Date of Birth (MM/DD/YYYY)
* Marital Status


Spouse’s Name
* Driver’s License #
* State Issued
* SSN
* Address
* City
* State
* ZIP
* Home Phone
* Cell Phone
* Email Address
* Confirm Email Address
* Occupation (can put “Student”)
Company/School Name
Work Address
City
State
ZIP
Supervisor Name
Supervisor's Phone
Who Referred You
* T-Shirt Size




* Polo Shirt Size




* Age group you most prefer working with




* Please rank all the other listed age groups you would prefer working with, in order of preference:

Camp directory
* I agree to have the following information in a camp directory:
  • My Name
  • Home Address
  • Email Address
  • Phone Numbers
If you want to have only some of your information in the camp directory, please list the desired information below: