Counselor In Training Program

         Registration Form

 

 

Returning Camper: _____                New Camper: _____

 

Camper’s Name __________________________________________________      Gender:    Male          Female

 

Age (as of 9/1/06) _________  Date of Birth _______________  Grade Entering (’06-’07) _____________

 

Parent(s)/Guardian(s) Name  ______________________________________________________________

 

Address (Street, City, State, Zip) ___________________________________________________________

 

Telephone _________________  Emergency (1)_____________________  (2)_______________________

 

E-mail ________________________________________________________________________________

 

Are you a 4-H Member?                   Yes         No         

 

How did you select this camp?        Website     ACA     Flyer     Mailing     Word of Mouth     Other

 

Please specify if other: ___________________________________________________________________

 

*Note* Please choose optional sessions.  If the session you sign up for is full, then we have the option of placing your child in another session.

 

Please enter the program you are applying for:       TRADITIONAL CAMP      HORSE CAMP

 

           

 

    Select Sessions Attending

       ($425.00 per session)

 

Enter:

1st-2nd-3rd Choices

 

                Total Per

                  Session

Session 1:

7/9-7/21

 

 

Session 2:

7/23-8/4

 

 

Session 3:

8/6-8/18

 

 

 

 

 

                                                                                                            Total:       ________     

          $100.00 Check or MO only non refundable deposit (per week):       ________

               Administration Fee:      $5.00   ­­­­

                                                           Total Amount Due by June 1, 2006:      ________

                                                      Sending deposit only: ____  Paying Full Amount:    ____­­­­­­­­­­­­­

 

 

WARNING – Horse Programs: Under Massachusetts Law, an equine professional is not liable for an injury to, or death of, a participant in equine activities resulting from inherent activities, pursuant to Chapter 128, Section 2D of the General Laws.

 

 

 

       **IMPORTANT**

 

These applications will be reviewed by the CIT Coordinator for acceptance of applicant.  If not accepted, amount paid thus far will be fully reimbursed.

 

 

 

Questionnaire

 

These questions are required to be answered to help determine members of the C.I.T. program.  Please answer them in complete sentences either here or on another piece of paper.

 

1. Why do you want to become a C.I.T. ?

 

2. What attributes do you think make a good camp counselor?

 

3. What makes up a good camp program?

 

4. Please enclose one letter of recommendation from a non-family member adult who can speak to your personal attributes.