Counsellor-in-Training (CIT) Application, Summer 2015
Name:______
Address:______
______
______
Date of Birth:______Grade:______Sex:______
School:______
Phone:______Email:______
Please indicate which half of the summer you would like to spend with us. Note that when you choose a half, it means that you are attending all three camping sessions listed.
First Half: ______Second Half: ______Either Half:______
FIRST HALF
Session:Camp Dates:Camp Ages: Length of Camp:
1 Monday, June 29 – Saturday, July 4 7 & 8 6 days
2Tuesday, July 7–Wednesday, July 15 9 & 10 9 days
3Saturday, July 18 – Sunday, July 26 11 & 12 9 days
SECOND HALF
Session:Camp Dates:Camp Ages: Length of Camp:
4Thursday, July 30 – Saturday, August 7 11 & 12 9 days
5Monday, August 10 – Tuesday, August 18 9 & 10 9 days
6Friday, August 21 – Wednesday, August 26 7 & 8 6 days
Do you have any of the following qualifications? If so indicate the year of completion.
First Aid:______CPR:______
Bronze Medallion:______Bronze Cross: ______
Babysitting Course:______
Tell us a little about yourself (i.e. hobbies, interests, etc.):
______
Why are you interested in joining our CIT Program?
______
Do you have any special skills or talents that you would be interested in sharing with the children? If so please specify:
______
Have you had any experience working with children (babysitting, day camps, etc.)?
______
Oak Acres has a strict no romantic relationships, smoking, drinking and/or drugs policy. Are you willing to abide by these rules while at camp? ______
Please name a reference (i.e. teacher, coach, a non-relative) who would support your application to become a CIT.
Name:______
Phone number:______
Relationship:______
I declare that the information contained herein is accurate to the best of my knowledge and I hereby provide authorization to D.P. Murphy Inc. or any of its agents to verify any information provided on this application.
Applicants Signature:______
Date:______