2025 Counselor Registration – Acceptance

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Entry ID from Part I*

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Medical Clearance Date

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Counselor Workshop

Counselor Name*

This is a read only field passed from Part I.

First Last

Counselor Birth Date*

This is a read only field passed from Part I.

Are you over 18 years old?*

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Counselor Email*

This is a read only field passed from Part I.

Gender*

This is a read only field passed from Part I.

Camp Enrolled in:*

This is a read only field passed from Part I.

Will you be attending camp?*

Yes, I accept the assignment

No, I will not attend Camp this year

Provide reason for declining the assignment*

Cellular Device Policy Consent*

I have read and understand the cellular device policy on the Vraj Youth website. I also understand that I am responsible for enforcing the policy with my campers. In the event that the policy is not followed, I understand that the cellular device will be taken away. I agree to:

Pay $500 to get the device back

Signature*

First Last

Name

This field is for validation purposes and should be left unchanged.