COACH-IN-TRAINING APPLICATION

First Name: *

Last Name: *

Age: *

Gender: *

Telephone Number: *

E-Mail Address: *

School you attend: *

Entering Grade for 2024/25: *

Relative name enrolled in camp(if any):

Name of Parent/Guardian

Home Phone:

Cell Phone:

Work Phone:

E-Mail Address:

Relation to you:

Your Experiences

Summer Camp Experience

	Year	Name of Camp	Location of Camp	Camper, Volunteer or Staff?
1	Year	Name of Camp	Location of Camp	Camper, Volunteer or Staff?
2	Year	Name of Camp	Location of Camp	Camper, Volunteer or Staff?
3	Year	Name of Camp	Location of Camp	Camper, Volunteer or Staff?

Experience in Clubs, Sports, and Other Organizations or Volunteer work within your school or community:

	Name of Club/Team	Organization	Years as Member	Role/Responsibilities
1	Name of Club/Team	Organization	Years as Member	Role/Responsibilities
2	Name of Club/Team	Organization	Years as Member	Role/Responsibilities
3	Name of Club/Team	Organization	Years as Member	Role/Responsibilities

Job or Work related experience:

	Company Name	Job Title	Responsibilities	Dates of Employment
1	Company Name	Job Title	Responsibilities	Dates of Employment
2	Company Name	Job Title	Responsibilities	Dates of Employment

Current Certifications (Such as CPR, First Aid, Lifeguard, Babysitting, etc.):

	Type of Certification	Issuing Organization	Expires
1	Type of Certification	Issuing Organization	Expires
2	Type of Certification	Issuing Organization	Expires

Short Answer

1) What experience do you have working with youth ages 4-12? *

2) Please tell me about a counselor, mentor, coach, or adult that has been influential in your life. Please describe the skills/talents/behaviors of this person that you would want to model. *

3) What does "volunteerism" mean to you? *

4) Why do you want to volunteer to be a CIT this summer? *

Commitment

Please indicate the summer weeks you are available (minimum of 4 weeks): *Please note that if selected for the CIT program, the cost is $50/week*

Please read carefully:

-I certify that all of the information on this form is accurate and complete.

-I certify that I, the applicant, answered all short answer questions and not my parent/guardian or anyone else.

-I understand that if accepted into the Coach-In-Training program, I will be

expected to conduct myself in a manner consistent with the rules/policies of Super Stars Camp.

Applicant Signature: *

clear

Date * +

I give my permission for my child/ward to apply for acceptance to the Coach-In-Training

program, and will support my child/ward should he/she be accepted into the program.

Parent/Guardian Signature: *

clear

Date * +