Reference Form

Name of Applicant *required field

How long have you known the applicant? In what capacity?

Rate the applicant in the following areas:

Would you consider the applicant a good role model for children? yes no

Please Explain:

Is the applicant a team player and can she/he follow rules? yes no

Please Explain:

What words or phrases immediately come to mind when describing the applicant?

What weaknesses or limitations have you observed in the applicant?

My overall recommendation:

Enthusiastically recommend

Recommend

Recommend with reservations

Do not recommend

Your Full Name	*required field	Date
Position		Phone	*required field
Email Address	*required field

Thank you for taking the time to complete this reference. If you prefer to send this information to the camp office via mail or fax, please print and send it to the address or number below:

Banner Day Camp

1225 Riverwoods Road

Lake Forest, IL 60045

p. 847.295.4900

f. 847.295.0995

Please Check Appropriate Box	Below Average	Average	Above Average	Outstanding	Unknown	Additional Comments
Dependability
Promptness
Maturity
Work Ethic
Cooperation
Leadership
Enthusiasm
Responsibility
Patience
Flexibility
Communication
Loyalty