BJE Teen Service Corps CIT Application 2016

*Please note that the end of this application includes questions to be completed by the CIT applicant*

Choice of Session

Please indicate session:

Session 1: Monday, June 20 - Friday June 24 (Sinai Temple) Session 2: Monday August 1 - Friday August 5 (Valley Beth Shalom)

Camper Information

Last Name:

First Name:

Home Phone:

Cell Phone:

Camper Email Address:

Gender?

Date of Birth:

Grade Level for Summer 2016:

Name of school camper will attend for 2016-2017 school year:

Name of Syngagogue (if applicable):

What size t-shirt does your child wear?

Child lives with:

About Camper

Information in this section will be used to help us understand the needs of our campers, and plan accordingly.

Has camper participated in any prior camping programs?

Please describe:

Is camper familiar with the nature of the BJE Teen Service Corps program?

Has your child ever been denied enrollment or asked to leave a camp for disciplinary issues?

Please explain:

Has camper volunteered before?

Please describe:

Does camper have any special learning needs (providing this information helps us best prepare to make it a successful week for your child)?

Please describe:

Does your child have any physical or psychological condition which could impact upon his/her activities at camp?

Please describe:

Is there any special information you would like to share about your child that will help us to better understand his/her needs?

Please describe:

Parent/Guardian I Information

Please note that our office will use Parent/Guardian 1 as the first contact for all emails, forms, and communications. Please let us know if you want us to send communications to both Parents/Guardians.

Last Name:

First Name:

Street Address:

City:

Zip Code:

Home Phone:

Cell Phone:

Business/Office Phone:

Email Address:

Parent/Guardian II Information

Last Name:

First Name:

Street Address (if different than Parent/Guardian I):

City (if different than Parent/Guardian I):

Zip Code (if different than Parent/Guardian I):

Home Phone(if different than Parent/Guardian I):

Cell Phone:

Business/Office Phone:

Email address:

CIT Questionaire

Please tell us about why you are interested in being a CIT this summer:

Please tell us any of your previous leadership experiences:

Please tell us about any skills or qualities that you think will help you as a CIT:

Please tell us anything else you think will be helpful for us to know:

Applications will be due on or before March 15, 2016.

Phone interviews will be conducted after applications are reviewed.

Upon acceptance into the CIT program the registration fee will be due:

Registration

$225

Need assistance with this form?