Counselor/Staff Application
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St. Tikhons Summer Camp: July 2-8, 2023

Counselors will be selected for each station based on background, expertise, certifications, and references. Applicants are expected to be present without interruption at St. Tikhons from the evening of July 1st through the afternoon of July 8th. The Counselor Application Form and all Reference Forms are due postmarked by May 15th, 2023.  An email to notify applicants of their acceptance status will be sent with adequate time for clearances to be processed.

Kitchen staff must submit the below Counselor and all Reference Forms. They are also required to supply the appropriate background checks and child abuse clearances as required by Pennsylvania law and OCA Guidelines. Application must be postmarked no later than May 15th, 2023. An email to notify applicants of their acceptance status will be sent with adequate time for clearances to be processed.

I am applying for the following position at Saint Tikhons Summer Camp:

Select Counselor or Kitchen Staff

Contact Information

Date of Birth
Birth Sex
Primary Phone
Email Address
Name and Location of Parish
Emergency Contact: Name
Emergency Contact: Phone

Additional Information

T-Shirt Size

Length: Shoulder seam at collar to bottom hem. Width: Armhole to armhole across chest.

Skills, Certifications and Areas of Interest
Please list any applicable certifications and skills (mail a copy of any related certifications)

Please indicate five areas of interest as a counselor/staff.  Please understand the needs of the camp and campers will come first but we will also try to accommodate your talents and wishes.  

Areas of Interest

General Medical Information

Do you have any medical concerns that may arise at camp?
Do you have any allergies (seasonal, medicinal, or food-related)?
Please list any current medications


Please write 2-4 sentences in response to each question.

Why do you want to volunteer at St. Tikhon's Summer Camp?
What strengths or skill sets would you bring to St. Tikhon's Summer Camp should you be selected as a counselor or staff?
Do you have any prior experience working with children or at a summer camp? Explain.

Applicant Requirements and Release Statement:

Please initial each of the following lines to acknowledge that you will meet the following prerequisites of becoming a camp counselor/staff at St. Tikhons Summer Camp:


I will be at least 18 years of age by July 1, 2023.
I have the desire and the ability to work with the children who attend camp.
I will uphold and abide by the camp rules, and always maintain an Orthodox Christian environment at camp.
I will be present at the camp from 4 p.m. Sat. July 1st, 2023 through 4 p.m. Sat. July 8th, 2023 without interruption.
I will attend the mandatory pre-camp training/orientation session in person on July 1st, 2023. (Kitchen staff exempt.)

Policies and Documents Requiring Acceptance

I accept the Counselor/Staff Release Form.
I accept the Social Media Policy.
I attest that all the above information is true and agree to all of the contents of this application.
Applicant’s Signature
Please type your full legal name as your signature.

Non-Discriminatory Notice: The Diocese of Philadelphia and Eastern Pennsylvania Youth Programs, including St. Tikhons Summer Camp, does not and will not discriminate against any student, employee, or other person because of race, color, religious origin, age, sex, veteran’s status, or disability.  All portions of the application with supporting documentation postmarked no later than May 15th, 2023.


Please include photocopies of the following items:

  • Driver’s License or Photo ID
  • Health Insurance Card
  • Any Relevant Certifications
  • (CPR, Lifeguard, etc.)


Clearance Guidelines for 2023

OCA Guidelines now require use of the online Protect My Ministry program at This website enables the Diocese to run a background check on each volunteer. It also requires state-mandated child abuse clearances and criminal background checks to be uploaded in a location where they are available to the Diocesan and OCA administration. The Protect My Ministry program is mandatory, but the camp will cover the associated costs. After you are accepted as a counselor for this season, you will receive instructions about what you will need to submit this year in order to be in compliance.

Please mail forms to:

St Tikhons Summer Camp DOEPA
PO Box 123
South Canaan, PA 18472

Questions may be directed to:

All 2023 applicants must submit the three Reference Forms found in the link below.

Please see page 1 for the Clergy Reference Form. This form must be postmarked no later than May 15th, 2023, and should be mailed directly from your priest to the camp’s mailing address above or emailed to Fr. Michael Shepherd at

The other two Reference Forms must be postmarked no later than May 15th, 2023, and should be mailed with your application form to the camp’s mailing address above or emailed to Fr. Michael Shepherd at

Submitted By
Your Email

Countdown to Camp

125 slots pending approval of the 125 available
Reserve your spot today!

Saint Tikhon’s Summer Camp
PO BOX 123
South Canaan, PA 18459

Diocese of Eastern Pennsylvania