First Name:*
Last Name:*
Age: * 131415161718
Gender: * MaleFemale
Telephone Number: *
E-Mail Address: *
School you attend: *
Entering Grade for 2021/22: * 9101112
Relative name enrolled in camp(if any):
Name of Parent/Guardian
Home Phone:
Cell Phone:
Work Phone:
E-Mail Address:
Relation to you:
Summer Camp Experience
Year
Name of Camp
Location of Camp
Camper, Volunteer or Staff?
Experience in Clubs, Sports, and Other Organizations or Volunteer work within your school or community:
Name of Club/Team
Organization
Years as Member
Role/Responsibilities
Job or Work related experience:
Company Name
Job Title
Responsibilities
Dates of Employment
What experience do you have working with youth ages 4-12?
2) Please tell me about a counselor, mentor, coach, or adult that has been influential in your life. Please describe the skills/talents/behaviors of this person that you would want to model. *
3) What does "volunteerism" mean to you? *
4) Why do you want to volunteer to be a CIT this summer? *
Please indicate the summer weeks you are available (minimum of 4 weeks): *Please note that if selected for the CIT program, the cost is $50/week*
Week 1 (6/5 – 9) Week 2 (6/12– 16) Week 3 (6/19 – 23) Week 4 (6/26 – 30) Week 5 (7/3 – 7) *No camp July 4th Week 6 (7/10 – 14) Week 7 (7/17 – 21) Week 8 (7/24 - 28) Week 9 (7/31 - 8/4)
Please read carefully:
-I certify that all of the information on this form is accurate and complete.
-I certify that I, the applicant, answered all short answer questions and not my parent/guardian or anyone else.
-I understand that if accepted into the Coach-In-Training program, I will be
expected to conduct myself in a manner consistent with the rules/policies of Super Stars Camp.
Applicant Signature: *
Date*
I give my permission for my child/ward to apply for acceptance to the Coach-In-Training
program, and will support my child/ward should he/she be accepted into the program.
Parent/Guardian Signature: *
