2011_leadership_development_programs_application

8/7/2019 2011_leadership_development_programs_application

http://slidepdf.com/reader/full/2011leadershipdevelopmentprogramsapplication 1/9

1

FOR YOUTH DEVELOPMENT

FOR HEALTHY LIVING

FOR SOCIAL RESPONSIBILITY

CAMP GREENVILLE

Leadership Development Programs Application:Counselor-In-Training and Service Corps Section 1 – Personal and Family InformationCamper’s Full Name (First Middle Last): ___________________________________________________

Preferred Name: __________________________ Where did you hear about Camp: ________________

Sex: ___ Female ___ Male Number of summers at Camp Greenville including this year: _

Home Phone: (____) ____________________ Mobile/Other Phone: (____) _____________________

Date of Birth: ____/____/____ Age as of June 1st: _____ Current grade in School: ______

Email Address: ______________________________________________________________________Address where correspondence should be mailed:

Street: ____________________________________________________________________

City: ______________________________ State: ____________ Zip Code: _____________

Country if not United States (US): _____________________________________

Which school do you attend? _________________________________________________________

Parent/Guardian 1 Name: (First and Last): __________________________________________________

Parent/Guardian 1 email: ______________________________________________________

Home Phone: (___) ___________ Mobile Phone: (___) ___________ Work Phone: (___) _________

Parent/Guardian 2 Name: (First and Last): __________________________________________________

Parent/Guardian 2 email: ______________________________________________________

Home Phone: (___) ___________ Mobile Phone: (___) ___________ Work Phone: (___) _________

Are parents divorced or separated: ___ No ___ Yes – If yes, with whom do you live? ____________

Section II – Counselor-In-Training (CIT)Eligibility: You must currently be in the 10th grade or higher.Instructions: Indicate order of preference (1 – being first choice, 2 – being second choice, etc.) and mark

any session you cannot attend with an “X”.

__ CIT Session A (2-weeks: Sunday, June 12 – Saturday, June 25; $1475.00)

__ CIT Session B (2-weeks: Sunday, June 26 – Saturday, July 9; $1475.00) __ CIT Session C - Females Only (2-weeks: Sunday, July 10 – Saturday, July 23; $1475.00)

__ CIT Session D (2-weeks: Sunday, Sunday July 24 – Saturday – August 6; $1475.00)



Section III – Service Corps

Eligibility: Applicants should currently be in the 9th grade or 10th grade. Firstconsideration for positions in the Service Corps is given to applicants who areregistered for another camp session. Individuals not registered for a camp session ar

eligible to apply, but will be considered by availability of open spaces. Are you registered for any other camp session? (Circle one): Yes No

Which session? ______________________ Dates of your camp session: ___________________

Instructions: Indicate order of preference (1 – being first choice, 2 – being second choice, etc.) and mark any session you cannot attend with an “X”. Please note:

• We recommend that 2 weeks be the maximum amount of time serving in Service Corps.

• Time in Service Corps may be limited in order to allow more people the opportunity to serve.• Preference is given to those who can volunteer contiguous to their camp session.

Preference Session

ID

Cost (registered for

another camp session) Cost (not registered for

another camp session) Dates

__________ SC-A $125 $380 Sunday, June 5 - Saturday, June 1

__________ SC-B $125 $380 Sunday, June 12 - Saturday, June

__________ SC-C $125 $380 Sunday, June 19 - Saturday, June__________ SC-D $125 $380 Sunday, June 26 - Saturday, July

__________ SC-E $125 $380 Sunday, July 3 - Saturday, July 9__________ SC-F $125 $380 Sunday, July 10 - Saturday, July 1__________ SC-G $125 $380 Sunday, July 17 - Saturday, July 2

__________ SC-H $125 $380 Sunday, July 24 - Saturday, July 3

__________ SC-I $125 $380 Sunday, July 31 - Saturday, Augus

Section IV – Experience and Interest Questions for Service Corpsand CIT, Agreement and Conditions

Instructions Please respond to each of the following questions accurately and honestly in the spaces below(attach additional paper if needed).

Work experience:Employer/ Company __________________________

Address: ___________________________________Phone number: ______________________________Supervisor: _________________________________

Job title and responsibilities: ______________________________________________________________

Employer/ Company _______________________

Address: ________________________________Phone number: ___________________________Supervisor: ______________________________

Job title and responsibilities: _________________________________________________________

Leadership positions:

Club/ Organization: _________________________Position/ office held: ________________________

Responsibilities: ___________________________

_________________________________________

Club/ Organization: _______________________Position/ office held: ______________________

Responsibilities: _________________________

_______________________________________

Experience working with children:With whom: ________________________________How long: _________________________________

Responsibilities: _____________________________

__________________________________________

With whom: _____________________________How long: ______________________________

Responsibilities: __________________________

_______________________________________



Leadership Development Interest Questions: 1. Why do you want to be in Service Corps or the CIT program?

2. What qualities do you possess that would enable you to be an effective CIT or SC member?

3. Being a CIT or in Service Corps is an honor, but it is important to remember that you are taking an

important step up into a leadership role. How will your past experiences and abilities help to make the

campers’ experience more memorable?

4. What is a personal achievement you are proud of and why?

5. Name 3 Camp Greenville activities or projects you think you would be able to assist and list any

experience you may have in those areas.



Leadership Development Expectations & Agreement

• I realize safety must be first priority when working with both campers and counselors. I will constant

strive to be aware of possible hazards and to learn all required safety procedures and practice sincere

risk management.

• I understand that as a participant, I will assist in my cabin and with activities. I will give counselors myattention, respect, and enthusiasm, and will strive to provide meaningful service for the campers.

• I promise to put the needs and feelings of the campers before my own and to encourage and assist thecampers in cabins, morning activities, evening programs, and at meals to help cultivate friendships,

positive relations and great camp memories.

• I realize in order to have fun and get the most from my experience; I must avoid gossip, badlanguage, backbiting, and the forming of cliques. If I have a problem with another person, I will first

confront him/her in a mature manner. If the problem persists, I will inform an appropriate member othe administrative staff.

• I understand that the program is designed to develop leadership and maturity and gain anunderstanding of responsibility and service. Furthermore, I understand that I am still a camper and

must abide by all rules, policies, and procedures for all campers.

• I understand that my participation in the CIT or Service Corps program does not automatically qualify

me to be a staff person at YMCA Camp Greenville.

• I understand that failure to meet the standards of the program and/or to follow camp rules and

regulations may result in removal from the program and/or camp.

• By signing below, I pledge to put forth my best effort in adhering to the goals and mission of YMCA

and promise to abide by the terms set forth in this agreement as well as Camp’s policies andprocedures.

_________________________________ _______________________________

Participant Signature Date

Parent Consent

I understand that YMCA Camp Greenville assumes no responsibility for injuries or illness which my child

may sustain as a result of his/her physical condition or resulting from his/her participation in these

activities. In consideration of the privilege of participating at Camp, I hereby voluntarily release and

discharge YMCA Camp Greenville, its agents, contract services, servants, and employees from any and all

claims of injury, illness, death, loss or damage which my child may suffer as a result of his/her

participation in these activities. Furthermore, I understand that no accident or medical insurance isprovided.

I have read and agree to the terms and conditions as stated in this application/agreement. All information

is true and accurate to the best of my knowledge.

________________________________ _______________________________

Parent/Guardian Signature Date



Terms and Conditions

The right is reserved to remove any camper who, according to the Director’s discretion, is judged detrimental tothe general welfare of the Camp, the program, the staff and/or other campers. Furthermore, there is no refund duethe parent or guardian if the child is removed. If the child is withdrawn for illness at the direction of a physician, aprorated amount of unused tuition will be refunded. No reduction in fees is made for late arrival or early departure.Application and registration for Camp constitutes acknowledgment that there is a certain degree of risk andpossible injury by nature of the Camp and its activities. The parent/guardian furthermore agrees that in the eventthey cannot be reached in an emergency situation, permission is given to the physician designated by the Camp tohospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for the camper.Permission is granted for YMCA Camp Greenville and/or the persons acting for or through them, the right to usereproduce, assign and/or distribute photographs, films, videotapes, and sound recordings of the camper for use inmaterials they may create for promotional, educational or documentary purposes.Arrival and Departure: “Check-In” for all sessions is always on Sunday from 2:30 PM until 4:30 PM and “Check-Out” for all sessions is always on Saturday from 10:00 a.m. until 12:00 noon. Arrival to and departure from Campshould be consistent with these times; any deviation from these times should be approved in advance and mayconstitute additional fees. If you are making transportation arrangements for your child, please be aware that weprovide service to the following Greenville, South Carolina Airport (GSP). There is an additional fee each way ($35.00)for transporting campers to/from these locations. We highly recommend making arrangements as early as possible.Health: Every camper is required to have a current health form (exam within one year of attendance) on file withCamp before they will be allowed to attend. This form must be completed by the parent/guardian and the child’sphysician. Completed forms are mandatory f or Camp attendance! Campers should be covered under an insurancepolicy provided by their parent(s) and/or guardian(s).Fees: Camp Greenville must receive a $100 deposit to process application. This fee is refundable if applicant is notaccepted into the Leadership development program. It serves to hold the spot of any potential candidates. The totalfees for the respective session (less the deposit, discounts, credits and/or scholarships) are due by April 22, 2011 (thefull balance is due to register for Camp after April 22, 2011) at YMCA Camp Greenville, P0 Box 9039, Greenville, SC29604; a late payment fee of $25 will be assessed for unpaid balances and registrations after April 22, 2011.Cancellations made in writing and received at YMCA Camp Greenville by December 31, 2010, will be eligible for arefund of deposit paid toward the 2011 season less a $50.00 processing fee. There will be no refund made oncancellations after December 31, 2010. Cancellation within 2 weeks of the session(s) registered for may result inliability for all fees. Any cancellation due to illness or accident must be accompanied by a written statement from thechild’s physician and a refund may be granted at the discretion of the Director.Campership (Scholarship) Funds: A limited amount of scholarship funds (referred to as “camperships”) areavailable each year for campers that may need assistance in being able to attend Camp. Information on applying forcampership funds and an application form are available upon request. Those desiring a camp scholarship mustcomplete a Camp Scholarship Application to be considered for a scholarship.Application or registration does not guarantee the opportunity to any activity, program, cabin or cabinmate. Please refer to the most recent copy of the Parent Handbook and/or additional materials that may be applicable toenrollment and attendance at Camp.

The YMCA of Greenville, following the example of Christ, builds healthy spirit, mind, and body for all.

Complete Application checklist:

□ Fully filled out Application, everything answered to the best of your ability□ 2 complete Reference forms that accompany your application□ $100 deposit payment per program, (i.e. if CIT & SC = $200) with check or credit card

□ Mailed to: YMCA Camper Services Leadership Development Program PO Box 9039Greenville, SC 29604

Once your completed application packet is received at Camp, you will be contacted to schedule an

appointment for an interview. Remember: Only fully complete packets will be considered, priority given tothe ones that come in first.

After your interview has been completed, you will be notified of your placement in the program.

Final payment will be due once you have received a written confirmation of your acceptance into aprogram. Or a refund will be given of your deposit if you are not accepted.

Method of Payment____ Check/Money Order (made payable to YMCA Camp Greenville) Amount: $_______________Or Credit Card: ___ Visa ___ MasterCard ___ Discover ___ American ExpressAmount to be charged to card: $____________Card holder names as appears on card: _________________________________________________________Billing address for card: _________________________________________ Zip: ________________________Card Number: ______________________ Security Code: ___________ Expiration Date: _________________




FOR HEALTHY LIVING


CAMP GREENVILLE

Leadership Development Programs:Counselor-In-Training and Service Corps

Reference Form Applicant Name: _____________________________________ Program(s): _______________________

The above-named person is applying to participate in a Leadership Development Program (Counselor-In-Training and/or Service Corps) at YMCA Camp Greenville for the upcoming summer. Written references

are required before an applicant will be considered. References should be from persons who know the

character of the applicant (teachers, coaches, youth ministers, neighbors, etc.). References submitted bypersonal friends or family members may not be considered. The applicant has not waived any right to sethis evaluation. Thank you for taking the time to complete a reference on this individual.

Please mark the box which bestdescribes the applicant’s ability in

each area.

Superior VeryGood

Average Fair Poor Unknown

Initiative

Responsibility and Reliability

Resourcefulness and Creativity

Cooperativeness with Adults

Cooperativeness with Peers

Punctuality

Communication Skills

General Attitude

Trustworthiness and Honesty

Observance of Rules and RegulationsSafety Habits

Judgment

Receptiveness to Suggestions / Criticism

General Appearance

Physical Stamina

Emotional Maturity and Stability

Self Confidence

Social Concern for Others

Leadership Ability

Willingness to go beyond what’s expected

What are the applicant’s most significant strengths?

What are the applicant’s most significant weaknesses?



How long have you known the applicant and in what capacity?

How do you think this person will do in a leadership program? What is their work/service ethic?

How would you rate this applicant as a role model for others? ___Excellent ___Good ___Fair ___Poor

Please address any area not covered in the previous sections that you feel may be helpful in reviewing this

candidate’s application: outstanding characteristics, achievements, etc., or concerns, questionablebehavior, etc. Please feel free to attach an additional sheet if necessary.

Your Name (Printed):__________________Occupation / Place of Employment: _____________________

Email: _________________ Phone Numbers: Home: (_____) ___________ Mobile (____) _________

Signature: ______________________________ Date: _________________________________

On behalf of YMCA Camp Greenville and the candidate, we would like to thank you for your time and effortin completing this reference form. Please return the reference form to the applicant and they will

submit it with their application. If you would like to insure the confidentiality of the information you

have provided, please personally place this and any additional information in an enveloped, seal theenvelope securely, and sign your signature along the seal on the envelope before returning it tothe applicant.





FOR HEALTHY LIVING


CAMP GREENVILLE

Leadership Development Programs:Counselor-In-Training and Service Corps

Reference Form Applicant Name: _____________________________________ Program(s): _______________________

The above-named person is applying to participate in a Leadership Development Program (Counselor-In-Training and/or Service Corps) at YMCA Camp Greenville for the upcoming summer. Written references

are required before an applicant will be considered. References should be from persons who know the

character of the applicant (teachers, coaches, youth ministers, neighbors, etc.). References submitted bypersonal friends or family members may not be considered. The applicant has not waived any right to sethis evaluation. Thank you for taking the time to complete a reference on this individual.

Please mark the box which bestdescribes the applicant’s ability in

each area.

Superior VeryGood

Average Fair Poor Unknown

Initiative

Responsibility and Reliability

Resourcefulness and Creativity

Cooperativeness with Adults

Cooperativeness with Peers

Punctuality

Communication Skills

General Attitude

Trustworthiness and Honesty

Observance of Rules and RegulationsSafety Habits

Judgment

Receptiveness to Suggestions / Criticism

General Appearance

Physical Stamina

Emotional Maturity and Stability

Self Confidence

Social Concern for Others

Leadership Ability

Willingness to go beyond what’s expected

What are the applicant’s most significant strengths?

What are the applicant’s most significant weaknesses?



How long have you known the applicant and in what capacity?

How do you think this person will do in a leadership program? What is their work/service ethic?

How would you rate this applicant as a role model for others? ___Excellent ___Good ___Fair ___Poor

Please address any area not covered in the previous sections that you feel may be helpful in reviewing this

candidate’s application: outstanding characteristics, achievements, etc., or concerns, questionablebehavior, etc. Please feel free to attach an additional sheet if necessary.

Your Name (Printed):__________________Occupation / Place of Employment: _____________________

Email: _________________ Phone Numbers: Home: (_____) ___________ Mobile (____) _________

Signature: ______________________________ Date: _________________________________

On behalf of YMCA Camp Greenville and the candidate, we would like to thank you for your time and effortin completing this reference form. Please return the reference form to the applicant and they will

submit it with their application. If you would like to insure the confidentiality of the information you

have provided, please personally place this and any additional information in an enveloped, seal theenvelope securely, and sign your signature along the seal on the envelope before returning it tothe applicant.


Documents

2011_leadership_development_programs_application