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# ______ CAMP “REPUBLIC” August 10th – 16th (?) APPLICATION FORM 1. Contact Information Name (first and last): Date of birth: Address: Cell/Home phone #: E-mail address: 2. University Information Institute/ University attending: Specialization: Year of study: 1st 2nd 3rd 4th 5th 3. Rate your level of English ability in My Self-rating of my ability in SKILL AREA Excellent Good Fair Poor Listening Speaking Reading Writing 4. In order to participate in Camp Republic, you must accept the terms and conditions of the camp. Campers should refrain from any use of drugs or alcohol; any students caught with these substances or under the influence of them will be immediately removed from the camp at their own expense. No campers can visit cabins with campers of the opposite sex after bedtime hours. Absolutely no fighting or use of discriminatory language will be tolerated and will be met with immediate removal from the camp. All campers must 18 years or older by start of camp. Furthermore, Peace Corps and Shelter + are not responsible for any lost items, or personal injury and health issues due to negligence. By signing, you agree to and understand all terms and conditions of Camp Republic Signature: __________________________________ 5. Written Response Question – Your acceptance in this camp will be based upon your ability to sufficiently answer the question in English. If you could be any one of the Greek Olympian Gods or Goddesses, WHO would you be and WHY? ZEUS (king of the gods and mankind, god of weather and justice), HERA (queen of the gods, goddess of women and marriage), DEMETER (the natural goddess of agriculture and vegetation), POSEIDON (the moody god of the seas), HESTIA (the calm goddess of the household), DIONYSUS (the joyful god of wine and drama), APOLLO (the youthful god of the sun and music), ARTEMIS (the wild goddess of nature and the moon), ATHENA (the sophisticated goddess of wisdom and the arts), ARES (the fierce god of war), HERMES (the clever god of trade and luck), APHRODITE (the sensual goddess of love and beauty), HEPHATEUS (the disfigured god of technology), or HADES (the gloomy god of the dead)?