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Name:
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Email Address:
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Home Address:
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City:
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State:
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Zip:
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Home Phone:
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Cell Phone:
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Age (as of June 19th):
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Education:
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Scouting History:
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Are you currently registered with the BSA?
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Unit Number & Council:
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Why do you want to work on camp staff?
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First Choice:
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Second Choice:
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Third Choice:
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Dates available for employment:
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Comments:
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