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Moorelands 2011 Summer Camp Reference Form

 

Name of the applicant:
Your name
Your relationship to the applicant
In which of the following settings have you observed the applicant
How long have you known the applicant
We may telephone you if we have further questions. Please include your telephone number
Your E-Mail address
You will be contacted to verify this reference)

 
Moorelands Camp works with Toronto youth affected by poverty to provide them with positive and fun experiences to help strengthen their confidence, competence and character.

Our expectations of our staff members at Moorelands are very high. Our programs are intentional; we want to use every opportunity to have a positive impact on the youth we serve. Working at Moorelands requires a tremendous amount of physical activity, creative energy, emotional investment and patience.

Your honest evaluation of the applicant's character and capabilities will be greatly appreciated. Please comment where possible.

The Applicant Strongly     Strongly
Agree «--» Disagree		 Comments
Displays emotional
maturity & stability
Accepts guidance, supervision
and feed back
Acts responsibly
Displays a good
sense of humour
Adjusts well to new situations
Is able to lead or follow
as the occasion demands
Demonstrates mature conduct
in peer relationships
Makes good decisions, keeps self and others safe
Is caring, mature, responsible
Accepts others and is not judgemental
Is enthusiastic, fun, and energetic
Works effectively with others
Shows a willingness/ability to follow direction
Desires to put the needs of children ahead of their own
Has a positive attitude and overcomes challenges
Responds positively to change
Is organized, uses time wisely
Is socially aware, tactful and friendly
Is able to guide and motivate children
Shows respect for property and equipment
Is known to be responsible and reliable
Respects organizational boundaries and policies

 
Is he/she a smoker?
Yes No Not Sure

 

Please describe what you have observed when this applicant has worked with children/teens in a leadership role.
Have not observed
Comments
Would you entrust the applicant with the direct care and influence of your child?
Yes No
If no, please explain
Are there any characteristics which might reduce the effectiveness of the applicant
in the camp program or community?
Yes No
Comments
Has the applicant proven to you that he/she can control their emotions?
Yes No Have not observed
Comments
Does the applicant get along well with peers and those in leadership?
Yes No
Comments
In what areas would you like to see the applicant grow?
What strengths does the applicant posess in regards to the position for which he/she has applied?
Additional comments:

Thank-you for your time and effort in contributing to the quality of our camp. If you have any questions or comments please call our Toronto office at 416-466-9987 x 306.

At Moorelands, we recognize the inherent value of all children and youth. We work with Toronto children and youth affected by poverty to provide them with positive and fun experiences to help strengthen their confidence, competence and character.