Jr. Counselor (CIT) Form for Camp 2019 – Capen Hill Nature Sanctuary

Please fill out form below. If you would like to donate to this program (free for Jr. Counselors but donations would be appreciated ) please press the donate button!

NEW Counselor in Training (CIT) form Capen Hill Science and Nature Camp 2023 (Age 14 and up)

This form needs to be filled out by all volunteers.

"*" indicates required fields

New Counselor in Training (CIT) Form 2023

For new CIT's that have never been trained. Ages are 14 and up. You will be at Camp to help with the groups of campers according to age as well as receive community service hours. One-time fee is $150.

Name*

First Last

Street and Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Enter Email Confirm Email

Phone*

A short description of any previous experience.

List 3 references and phone numbers.

Additional Information you would like us to know.

Name*

First Last

Emergency Name and Phone Number

Phone*

Emergency Phone Number

Cori Info Needed: First Name, Last Name, Middle Name*

Cori Info Needed: Place of Birth*

Cori Info Needed: Date of Birth*

Cori Info Needed: Last Six Numbers of Social Security*

Current Address*

Cori Info Needed: Mother's First Name, Last Name and Maiden Name

Cori Info Needed: Father's First and Last Name

Cori Info Needed: State Driver's License Number If Applicable

Upload Vaccination Record

Max. file size: 2 MB.

Copy of your vaccination record needed. You may also have the doctor's office mail it to Capen Hill Nature Sanctuary, P.O. Box 218, Charlton City, MA 01508

Weeks you would like to volunteer (can always change)*

Session 1 (July 10- 14)

Session 2 (July 17-21)

Session 3 (July 24- 28)

Session 4 (July 31-August 4)

Camp runs for 4 one week sessions from 8:30 to 3. You can pick as many weeks as you want. If you want to change your plans. you are able to do so but you need to let the director know.

Counselor in Training Fee*

Price:

One time Fee for the Counselor in Training Course

How would you like to pay: Check is second option.