Waterman Conservation Education Center

403 Hilton Road, Apalachin, NY

607-625-2221

Summer Day Camp CIT Application

Name__________________________________ Age________ Birth Date____________

Home Address ___________________________________________________________

Telephone: (home) ___________________ (cell)_____________________

Email________________________________________________________

Special certifications: Red Cross Baby Sitting Course _______________

First Aid____________ CPR ____________ Lifeguard ___________

Education: List schools attended and/or presently attending.

Name and School Location Program of Studies Year

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Please answer the following questions with brief but complete paragraphs:

1. Outline any special talents that help to qualify you for the position desired.

_______________________________________________________________________

_______________________________________________________________________

2. What type of experience do you have working with children?

_______________________________________________________________________

_______________________________________________________________________

(over)

3. Why do you want to be a Counselor in Training?

_____________________________________________________________________

_____________________________________________________________________

References: Please include accurate and complete address information.

Personal References (character references)

Name Address City State Zip Phone

_____________________________________________________________________

_____________________________________________________________________

______________________________________________________________________

Parental Permission:

I give my son or daughter permission to take part in the Summer Day Camp program at Waterman Conservation Education Center as a Counselor in Training. I have discussed it with him/her and he/she is aware of the responsibilities involved when working with children. I understand that this is an unpaid (volunteer) position that will supply my child with valuable employment experience.

Parent or Guardian (Please Print) Signature of Parent or Guardian

Camp Begins July 6 and ends August 28. 9 AM to 3 PM. If volunteering more than one week, the weeks do not need to be contiguous.

Questions? Please call 625-2221 or email info@watermancenter.org.

Please return form to: Waterman Conservation Education Center

403 Hilton Road

Apalachin, NY 13732