DCA Reference Form

DCA Application Reference Form

Please assist us by completing this form with your candid thoughts about the applicant. Successful DCA’s are open to learning, ready to participate fully in camp, and enjoy working with both youth and adults. They should enjoy outdoor living and possess the abundant energy that summer camp leadership demands. Please give us your candid opinion about this applicant. References are kept confidential.

Name of Applicant*
How Long have you known applicant?*
In what capacity*
If you were an employer, would you re-employ this applicant?*
- Yes
- No
Assessment
Please indicate your assessment of the applicant in each of these areas:
Physical Health*
Personal relations with youth*
Personal relations with peers.*
Personal relations with older adults*
Sense of humor*
Responsibility*
Flexibility*
Judgement*
Emotional Stability*
Leadership*
Interest in working with children*
Cooperation*
Receptive to new ideas*
Initiative / Ability to motivate self*
Social poise*
Tidy personal appearance*
Accepts supervision and guidance*
Outdoor skills*
Creative skills*
Are you willing to have a child of yours under the leadership and influence of the applicant?*
- Yes
- No
To the best of your knowledge, has the applicant ever had trouble with drugs?*
- Yes
- No
To the best of your knowledge, has the applicant ever had trouble with alcohol?*
- Yes
- No
Any additional comments about the individual.
Your information
Your Name*
Position*
Email*
Telephone*
Address
City
State
Zip

Young people want to shape the world.

Camp Fire provides the opportunity to find their spark, lift their voice, and discover who they are.

In Camp Fire, it begins now.

Light the fire within

DCA Reference Form

DCA Application Reference Form

Assessment

Your information