Camp Lookinback Camp Counselor Application – Beaumont Heritage Society

Camp Lookinback is currently accepting camp counselor applications for teens ages 13-17 for the week of July 9-12, 2024, from 8:30 am-12 pm.

Please fill out the form below and we will contact you with the status of your application.

Camp Counselor Application

Counselor(s) Name & Age(Required)

In case of emergency, and if the Beaumont Heritage Society is unable to contact any of the listed contacts, do we have permission to have your child taken to the emergency room?

Parent/Guardian Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Emergency Contact #1

Name Number

Emergency Contact #2

Name Number

Allergies or other medical conditions we need to know about? (Including medications) If none, type NONE.(Required)

List any prior experience

Preferred Age Groups

6-7 year olds

8-9 year olds

10-11 year olds

Emergency Permission: In case of emergency, I authorize the Beaumont Heritage Society staff to obtain emergency medical care for my camper(s) as needed.

I Accept

I Decline

A parent/guardian signature will be required on the first day of camp.

To the fullest extent permitted by applicable law, I will hold harmless and indemnify the Beaumont Heritage Society, its agents and employees, against any and all claims and actions arising out of my child's/children's participation in the Camp Lookinback summer camp, including, without limitation, expenses, judgments, fines, settlements and other amounts actually and reasonably incurred in connection with any liability, suit, action, loss, or damage arising or resulting from my child's participation in the Camp Lookinback summer camp.

I Accept

I Decline

A parent/guardian signature will be required on the first day of camp.

Photography Permission: I authorize the Beaumont Heritage Society staff and agents permission to photograph and video my camper(s) while attending summer camp for the explicit purpose of creating camper memory books to take home, social media use, and creation of print advertising materials.

I Accept

I Decline

A parent/guardian signature will be required on the first day of camp.