Counsellor in Training Application Form

COUNSELLOR IN TRAINING APPLICATION FORM

17-18 YEAR OLD

AUGUST 20-26, 2023

All Counsellors in Training (CIT) applicants must:
(a) be a least 16 years by Dec. 31st (Note: subject to camp/leadership experience and will receive high school volunteer hours accordingly),
(b) complete this application form and return it no later than May 14
(c) participate in an interview (either via telephone or in person) and receive additional information and forms to be filled out once accepted,
(d) provide the registration fee upon acceptance by June 1st.

CIT APPLICANT'S FIRST NAME

CIT APPLICANT'S LAST NAME

ԱՆՈՒՆԸ ԵՒ ՄԱԿԱՆՈՒՆԸ ՀԱՅԵՐԷՆՈՎ - FIRST AND LASTNAME IN ARMENIAN

GENDER *

DATE OF BIRTH *

CIT APPLICANT'S EMAIL *

Confirm Email

CIT APPLICANT'S PHONE

ADDRESS *

APT. # *

CITY *

PROVINCE *

POSTAL CODE *

FATHER'S NAME *

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MOTHER'S NAME *

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Last

FATHER'S EMAIL *

Confirm Email

MOTHER'S EMAIL *

Confirm Email

HOME PHONE *

FATHER'S CELL PHONE

FATHER'S BUSINESS PHONE

MOTHER'S CELL PHONE

MOTHER'S BUSINESS PHONE

WHICH PARENT CAN WE REACH DURING THE TIME YOUR CHILD IS AT CAMP? *

EMERGENCY CONTACT INFORMATION (OTHER THAN PARENT/GUARDIAN) *

EMERGENCY CONTACT INFORMATION RELATIONSHIP *

EMERGENCY CONTACT INFORMATION PHONE *

CONFIDENTIAL MEDICAL INFORMATION *

FAMILY PHYSICIAN

PHYSICIAN'S PHONE

LIST ALL ALLERGIES OR SENSITIVITIES TO ANY DRUGS, FOODS, OR ENVIRONMENT *

* An additional medical form will be mailed with the welcome package and all medication will be administered to the child as directed in writing.

NAME TWO FRIENDS OR ACQUAINTANCES, OF SIMILAR AGE AND GENDER, YOU’D LIKE TO BE BUNKED WITH AND ALL OTHER CONSIDERATIONS/REQUESTS

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SELECT YOUR CAMP ARARAT T-SHIRT SIZE *

IS THIS YOUR FIRST OVERNIGHT CAMP EXPERIENCE? *

DESCRIBE YOUR INVOLVEMENT IN YOUR COMMUNITY AND VOLUNTEERING (SPORTS, SCHOOL, CHURCH, CAMP, OTHER) *

DESCRIBE YOUR PREVIOUS EXPERIENCES AT CAMP

WHAT DO YOU HOPE TO LEARN FROM THE CIT PROGRAM?

PLEASE CHECK THE APPROPRIATE PROGRAM FOR WHICH YOU HAVE SUCCESSFULLY EARNED CERTIFICATION AND PROVIDE COPIES

Bronze Cross
National Lifesaving Society/ NLS. NB: Camp Ararat will reimburse a one time NLS fee with completion and commitment to a week to camp.
Standard First-Aid/CPR
Leadership Development/Preparation Experience (eg. Ontario High Five Program)
Outdoor or Water Certification/Training
Babysitting Certificate
Other Certification (please list):

FEE PAYMENT OF $700 WILL BE DUE UPON ACCEPTANCE BY JUNE 1st VIA E-TRANSFER TO PAYMENT@CAMPARARAT.CA . PLEASE INCLUDE THE CIT'S NAME AND the NAME AND ADDRESS OF the TAX RECEIPT IN SUBJECT LINE. * Fees are reimbursable until July 1st, 2023 or in accordance with public health measures.

BY SUBMITTING THIS APPLICATION I/WE CONFIRM THAT AS PARENT/GUARDIAN OF THE CHILD HAVE SOUGHT COMPETENT ADVICE WITH RESPECT TO MY/OUR CHILD’S HEALTH AND WELL BEING PRIOR TO COMPLETING THIS FORM. I/WE AGREE TO RELEASE THE ARMENIAN HOLY APOSTOLIC CHURCH CANADIAN DIOCESE, CAMP ARARAT AND ITS MEDICAL STAFF, COUNSELLORS AND SUPERVISORS OF ANY LIABILITY. IN THE CASE OF AN EMERGENCY, MEDICAL/HOSPITAL SERVICES MAY BE REQUIRED FOR THE CAMPER/PARTICIPANT. I/WE UNDERSTAND THAT EVERY REASONABLE EFFORT WILL BE MADE BY THE CAMP/HOSPITAL SERVICES TO CONTACT ME/US. THIS IS MY/OUR AUTHORIZATION TO HAVE MEDICAL PERSONNEL AND/OR HOSPITAL STAFFS ADMINISTER MEDICAL OR SURGICAL SERVICES, INCLUDING ANAESTHESIA AND DRUGS TO THE CHILD. I/WE UNDERSTAND THAT ANY COSTS RELATING TO SUCH MEDICAL SERVICES BEING REQUIRED WILL BE MY/OUR RESPONSIBILITY. *

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By submitting this application, we confirm that as parent/guardian of the child and the child have read the Code of Conduct, the Freedom of Information and Protection of Privacy Act, and the Waiver and Release of Liability Agreement (www.campararat.ca/code-of-conduct-privacy-waiver/) and agree to their terms and conditions and to extend our full cooperation to the Camp counsellors and staff during the child's stay at Camp Ararat. *

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