2026 Counselor Registration – Part II "*" indicates required fields EmailThis field is for validation purposes and should be left unchanged. READ BEFORE STARTING THE APPLICATION! 1. Health Information must be completed by a Parent or Legal Guardian if the counselor is under the age of 18 as of first day of camp he/she will attend.. 2. Entire Registration is online and in two parts. Part I is for counselor information. Part II is to submit a copy of the health insurance ID and camper health information. 3. Part II of the application must be submitted by in order to be considered for a counselor role. 4. Counselors will get final confirmation by May 10, 2026. 5. Please make sure to check your spam folder if you do not see your confirmation email in your inbox. 6. All submitted information is stored on a secure website. For more information on counselor registration please contact counselorreg@vrajyouth.net This field is hidden when viewing the formApplication Decision NotificationThis field is hidden when viewing the formMedical Clearance DueThis field is hidden when viewing the formCounselor WorkshopThis field is hidden when viewing the formApplication Withdrawal DateThis field is hidden when viewing the formEntry ID from Part IThis is a read only field passed from Part I.Are you over 18 years old?*This is a read only field passed from Part I.Parent/Guardian Email Address*This is a read only field passed from Part I. Parent/Guardian Name*This is a read only field passed from Part I. First Last Counselor Email*This is a read only field passed from Part I. 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.GenderThis is a read only field passed from Part I.Health Insurance Carrier*Subscriber ID*Subscriber Name*Group Number*Upload Copy of Front and Back of Health Insurance ID*Two files upto 2MB each are allowed. Make sure that the information on Health Insurance ID matches the health insurance related fields above Drop files here or Select files Max. file size: 5 MB, Max. files: 2. Counselor Health Information READ BEFORE STARTING THE APPLICATION! 1. Health Information must be completed by a Parent or Legal Guardian if the counselor is under the age of 18 as of first day of camp he/she will attend.. 2. Entire Registration is online and in two parts. Part I is for counselor information. Part II is to submit a copy of the health insurance ID and camper health information. 3. Part II of the application must be submitted by May 4th, 2026 in order to be considered for a counselor role. 4. Counselor will get final confirmation by May 10, 2026. 5. Please make sure to check your spam folder if you do not see your confirmation email in your inbox. 6. All submitted information is stored on a secure website. For more information on counselor registration please contact counselorreg@vrajyouth.net Check all of the following allergy or medical conditions that apply:* None Certain Foods Certain Medicines Bee Stings/Insects Seasonal Changes Other Provide specific information. e.g. Allergic to peanuts.*What are the symptoms the Counselor exhibits when having an allergic reaction/medical condition?*Does the Counselor take any medication for allergies, medical condition, or otherwise?* Daily As needed None Please list medication(s), dosage and frequency, including emergency medicine the Counselor carries.*Is there a need to keep medication at camp?* Yes No Are there any limitations/ restrictions of physical activities at camp due to allergies/medical condition?* Yes No If answered yes to any limitation/restriction, please specify.*Has the Counselor ever been hospitalized, gone to the emergency room, or visited a doctor due to an allergic reaction or for the medical condition?* Yes No If answered yes, please explain.*This is a required field.Does the Counselor have ADHD or other related disorder that camp counselors and adult volunteers need to be aware of for the safety of the child and others.*If yes, we will contact you for additional information. Yes No Parent/Guardian Consent*– I consent to the enrollment of my child in this youth gathering for the period indicated on this application. – I understand that the Camp committee, at its discretion, may decline the application based on the review of the application and submitted documents if it is concerned about the well-being of my child or others at camp. – I understand that my child cannot leave earlier than Saturday noon, unless explicitly requested by Camp Management. – I grant permission for my child to receive all necessary treatment or urgent care, as necessary. – I understand that I am liable for full payment of all medical and related expenses for my child during his/her stay at Vraj Camp. – Vraj is not liable for payment of any medical and/or any other expenses for my child. – My child has no/only mild allergy, as described by his/her physician. – Vraj facilities are used for food preparation with peanuts, tree nuts, soy, milk and wheat. – Vraj will not provide quarantined facility or meals with specific ingredients / dietary requirements. – I understand that medically trained persons are not available at Vraj camp and temple. Vraj Camp facility is located in rural are of Wayne Township, PA. In case of emergency, it may take up to 45 minutes to reach a nearby hospital. – As a parent, I understand that Vraj camp volunteers are not liable to provide adequate first-aid or health services. – My child is able to take care of his/her health issue and able to take his/her regular and emergency medicine without any assistance. – I, undersigned, hereby assume complete financial and other responsibility for all and every health and accident related expense on Vraj premises or on any excursions my child may take part in while attending Vraj Camp. – I voluntarily waive, release, and hold harmless Vraj / PMVS, its board, employees, and other volunteers from all claims, accidents, injuries, or death that may result from any act or activities during camp. – I understand that this gathering is informal family type of a gathering, and that the institution does not assume any legal responsibility of the attendee. – I hereby release PMVS and its associates, workers and volunteers of any liability arising from any accidents or injuries that may occur to the camper while attending the gathering. – I understand that hazing and bullying is criminal act and will not be tolerated at Vraj Youth Camp. All parties involved including witnesses have a responsibility to immediately report all incidents directly to the Camp Director with all necessary details. Without such cooperation, the Camp Director will not be able to take any immediate action. Appropriate action will be taken by the Camp Management as deemed necessary. – I understand that my child will be sent home on finding of possession of Illegal drugs, E-Cigarettes and/or cigarettes. Vraj camp is smoke and drug free facility. – Photographs and videos are for personal use only and not allowed for distribution or uploading online. – I provide permission to use my child’s photos taken at Vraj Youth events for Vraj related publications. – My child will not carry a cell phone with his/her to camp. If a cell phone is found in his/her possession, it will be disposed off and not returned back to the him/her or me. – I may receive Vraj events related emails. – I have read the Vraj Camp Rules and Regulations and we consent to abide by them. I have read , understand and consent to the above.Counselor Consent*-I consent to the enrollment of myself in this youth gathering for the period indicated on this application. – I understand that the Camp committee, at its discretion, may decline the application based on the review of the application and submitted documents if it is concerned about my well-being or others at camp. – I understand that I cannot leave earlier than Saturday noon, unless explicitly requested by Camp Management. – I grant permission for myself to receive all necessary treatment or urgent care, as necessary. – I understand that I am liable for full payment of all medical and related expenses for my child during his/her stay at Vraj Camp. – Vraj is not liable for payment of any medical and/or any other expenses for me. – I have no/only mild allergy, as described in this form above – Vraj facilities are used for food preparation with peanuts, tree nuts, soy, milk and wheat. – Vraj will not provide quarantined facility or meals with specific ingredients / dietary requirements. – I understand that medically trained persons are not available at Vraj camp and temple. Vraj Camp facility is located in rural are of Wayne Township, PA. In case of emergency, it may take up to 45 minutes to reach a nearby hospital. – As a cousnselor of legal age (18years or older)t, I understand that Vraj camp volunteers are not liable to provide adequate first-aid or health services. – I am able to take care of my health issue and able to take my regular and emergency medicine without any assistance. – I, undersigned, hereby assume complete financial and other responsibility for all and every health and accident related expense on Vraj premises or on any excursions my child may take part in while attending Vraj Camp. – I voluntarily waive, release, and hold harmless Vraj / PMVS, its board, employees, and other volunteers from all claims, accidents, injuries, or death that may result from any act or activities during camp. – I understand that this gathering is informal family type of a gathering, and that the institution does not assume any legal responsibility of the attendee. – I hereby release PMVS and its associates, workers and volunteers of any liability arising from any accidents or injuries that may occur to the camper while attending the gathering. – I understand that hazing and bullying is criminal act and will not be tolerated at Vraj Youth Camp. All parties involved including witnesses have a responsibility to immediately report all incidents directly to the Camp Director with all necessary details. Without such cooperation, the Camp Director will not be able to take any immediate action. Appropriate action will be taken by the Camp Management as deemed necessary. – I understand that my child will be sent home on finding of possession of Illegal drugs, E-Cigarettes and/or cigarettes. Vraj camp is smoke and drug free facility. – Photographs and videos are for personal use only and not allowed for distribution or uploading online. – I provide permission to use my child’s photos taken at Vraj Youth events for Vraj related publications. – My child will not carry a cell phone with his/her to camp. If a cell phone is found in his/her possession, it will be disposed off and not returned back to the him/her or me. – I may receive Vraj events related emails. – I have read the Vraj Camp Rules and Regulations and we consent to abide by them. I have read , understand and consent to the above.Emergency Contact Name – 1*Must be different than parent/guardian information provided in Part I of the application. First Last Relationship to Counselor – 1*Emergency Contact Number – 1*Emergency Contact Name – 2*Must be different than parent/guardian information provided in Part I of the application First Last Relationship to Counselor – 2*Emergency Contact Number – 2*Parent Signature*My signature above certifies that the information provided on Counselor Registration Part I and Part II is accurate. First Last Counselor Signature (if above 18 years)*My signature above certifies that the information provided on Counselor Registration Part I and Part II is accurate. First Last Δ