1 Step 1
Jr Counselor Camp Application 2021
Campers 9th grade

Thank you for your interest in becoming a Junior Counselor at Action Kids this summer. Our Junior Counselor program is both lots of fun and challenging!  We provide our Junior Counselors with leadership skills training, ongoing supervision and daily opportunities to put leadership into practice.  Junior Counselors work directly with the Leadership Program Leader and the Camp Director on teamwork, communication, problem solving and camper supervision.  Junior Counselors are required to commit to a minimum of 15 days over the course of the summer.

The Junior Counselor program is application based. Please make sure you complete all the steps.  Incomplete applications will not be considered.

Part One
Review of the expectations of all Jr Counselors.
Part Two

Short Answer

Part Three
Registration information. Parent or legal guardian must complete PART THREE

Part Four
Two references must be submitted on your behalf to Actin Kids Summer camp (NH state law). The reference forms can be from anyone outside your immediate family that can speak best to your character and has known you for at least a year.
  One reference from a relative may be included. References can be completed by the easy online form found on the "Register Here" page on our summer website.   It is your responsibility to communicate this information to your potential references.

Once all of the above have been received, Action Kids Camp Directors will review application.  If your application is accepted,  Action Kids staff will parent/guardian to complete the enrollment process, all required paperwork and submit medical forms. 

Part One: Expectations (To be completed by applicant)


Our Junior Counselors are expected to be positive role models all day, of every day they are with us!  Campers of all ages look to our Junior Counselors for care and direction.  We expect our Junior Counselors to demonstrate:

  • A high degree of personal responsibility​
  • A high level of maturity
  • Personal initiative and the ability to work independently
  • The ability to work positively and cooperatively with others throughout the camp day
  • A genuine desire to work with children
  • Successful participation in the Action Kids L.I.T. program (or a similar leadership or childcare focused experience)

Note of Intent: I enjoy working with children. I am willing to bring a positive and enthusiastic attitude to camp each day. I am ready and willing to learn. I am ready to be a positive role model for campers all day, every day. I am ready to sing camp songs and show camp spirit!
Part Two: Short Answer (to be completed by applicant)
Part Three: Camper Information (to be completed by parent)
Parent Information
Custodial Parent
Custodial Parent
Choose your Camp Dates
Week One ~ June 21 to June 25 ~ Wacky Wizards
Camp Only 8:00 to 4:45Whole week or Single days
Week Two ~ June 28 to July 2 ~ Star Wars
Camp Only 8:00 to 4:45Whole week or Single Day
Week Three ~ July 6 to July 9 ~ Super Sports (No camp July 5)
Camp Only 8:00 to 4:45Whole week or Single Day
Week Four ~ July 12 to July 16 ~ Disney Mania
Camp Only 8:00 to 4:45Whole week or Single Day
Week Five ~ July 19 to July 23 ~ Ninja Warriorfest
Camp Only 8:00 to 4:45Whole week or Single Day
Week Six ~ July 26 to July 30 ~ Color Wars (Three day minimum this week)
Camp Only 8:00 to 4:45Whole week or Three days
Week Seven ~ August 2 to August 6 ~ Wet N Wild!
Camp Only 8:00 to 4:45Whole week or Single Day
Week Eight ~ August 9 to August 13 ~ Code Name: Spy Kids
Camp Only 8:00 to 4:45Whole week or Single Day
Week Nine ~ August 16 to August 20 ~ Lights, Camera, ACTION!
Camp Only 8:00 to 4:45Whole week or Single Day
Week Ten ~ August 23 to August 27 ~ Summer Rewind
Camp Only 8:00 to 4:45Whole week or Single Day

b) Medical Issues/Allergies

Camp Rates and Payment Information

Full Weeks: $130 per week

July 6th Week: $104 per week

Single Days: $30 per day (15 day minimum)

Upon acceptance in the program, Action Kids staff will send more information regarding payment options. 

General Summer Camp Administrative Policies

Our summer camp refund policy:

  • Any date changes to your original camp registration can be made until May 15, 2021. Space permitting  All requests must be made in writing.
  • Minimum registration requirements: 15 days​,  Color Wars/Week Six: 3 day minimum
  • Make ups for missed camp days are not available.
  • Full refunds will be available if Covid related restrictions prevent us from operating during the 2021 summer camp season.
  • Full refunds less a $50 admin fee, will be available until 04/01/2021 should you choose to withdraw due to Covid-19 related reasons.  
  • We offer house credit for cancelled summer camp weeks, from 04/02/2021 to 05/15/2021. No refunds
  • No house credit or refund for any cancelled camp registration after May 15, 2021.


I, the duly authorized parent or guardian of the above-named Minor “Participant”, understand that the individual and/or group gymnastics and other physical exercise sessions, programs or activities conducted at Action Kids at Brentwood Commons, Inc. (hereafter “Action Kids”) may involve gymnastics, tumbling, fitness, trampoline, cheerleading, dance, ball sports, swimming and martial arts, as well as the use of exercise equipment, amenities and facilities owned and/or operated by Action Kids, its representatives or its contractors (collectively, the “Activities”).

I,  as the parent/guardian of the below-named Minor Participant, as a condition of authorizing their participation in such Activities do hereby agree to RELEASE and DEFEND, HOLD HARMLESS, and INDEMNIFY Action Kids, its shareholders, directors, officers, agents, faculty, volunteers, employees, representatives and contractors (hereinafter “the Releasees”) from all liability, claims, expenses, fees, fines, penalties, losses, suits, proceedings, actions and costs including attorneys’ fees and court costs, including personal injury and death, resulting from or arising out of their participation in the Activities whether caused by the alleged NEGLIGENCE of the Releasees or otherwise.

I understand that the Activities in which my child or ward will be engaged may be dangerous, and I, as their parent or guardian, voluntarily choose to assume those dangers. I also recognize that by participating in the Activities my child or ward may experience injuries including, but not limited to, death or disability, and I willfully ASSUME THOSE RISKS. I agree that THIS LIABILITY RELEASE AGREEMENT IS BINDING ON THE PARTICIPANT AND THEIR PARENTS OR LEGAL GUARDIANS, PERSONAL REPRESENTATIVES, HEIRS, AND ASSIGNS.

In the event of accident or emergency, I hereby authorize Action Kids to transport the Participant, or cause the Participant to be transported, to a medical facility for medical treatment and I agree to release, indemnify, defend and hold Action Kids and its representatives harmless with regard to same. I hereby agree to be fully and solely responsible for all medical expenses which may be incurred as a result of the Participant’s participation in the Activities.

I understand that my child or ward’s participation in the Activities at Action Kids may be photographed, video recorded, audio recorded, or otherwise recorded. I acknowledge that Action Kids retains the right to use such photographs, video or audio recordings or any other recording of events for publicity, advertisement or any other legitimate purpose and I hereby consent to such use.

FormCraft - WordPress form builder