Fall Staff application - The Wilds of New England

Name

Gender

Male

Female

Age

Date of Birth

Current Address

Home Address (if different from current)

Phone Number

Email Address

Are you a United States citizen?

Yes

No

Have you ever been convicted of or entered a plea of guilty/”no contest” to any misdemeanors or felonies (other than traffic violations)?

Yes

No

Please Explain

Have you ever participated in, been accused of, pleaded guilty/”no contest” to, or been convicted of abuse or any sexual misconduct?

Yes

No

Please Explain