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Counselors / CIT Application
Bill Germino
2023-01-17T10:53:15-05:00
Counselor Application
"
*
" indicates required fields
Counselor Information
Name
*
First
Last
Email
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Cell Phone
Home Phone
Address
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Street Address
City
State
Alabama
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District of Columbia
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Armed Forces Americas
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State
ZIP Code
Date of Birth
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MM slash DD slash YYYY
Parent Name
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Parent Email
*
Parent Phone
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Other Information
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
School Name
Grade in Fall 2023
Grade Point Average
I have been involved with Sebago before as a:
Counselor
Camper
No Previous Involvement
Do you attend activities at the center?
*
Please select an option.
No, I do not attend activities organized by a center.
Yes, I attend high school activities organized by the Chestnut Hill Center.
Yes, I attend activities organized by another center.
Availability:
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I am available for staff training June 17-19
I am available to serve at the camp from June 19-25
Why do you want to work at the Leadership Camp?
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50-75 words
What qualities do you think are necessary to be a truly good leader?
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50-75 words
Two core responsibilities of counselors are serving others and forming campers. Please describe how you have lived dedication to your own formation at the center you attend and how you have lived a spirit of service at our activities.
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50-75 words
Electronic Devices Policy
Preferably, electronic devices (smartphones, iPads, and the like) will be left at home. The reason for leaving these types of devices at home is to foster a tone of camaraderie and friendship. Unfortunately, at times, electronic devices have the opposite effect—tending to isolate people and be an obstacle to conversation. *If you do bring one of these devices, the staff will collect them upon arrival. There will be a couple of times during the camp that you will have access to them so you may respond to important messages or calls. (Coverage, however, may be quite limited.) Parents may reach participants at any time by calling Raymond Le Grand at (972) 904-1002 or Andy O'Meara at (617) 755-4644.
Medical / Insurance Information
Pertinent Health Information, including allergies, medications, etc.
*
Insurance Company
*
Insurance Company Phone #
*
Policy Number
*
Insurance Group Number (if applicable)
Waivers
Participation and Liability Waiver
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I hereby give permission for our son to participate in all activities conducted by SLC. We agree to hold the directors and staff harmless from any liability to anyone on account of any injuries to our son. I understand that SLC cannot be responsible for lost or broken items.I understand my son will comply with all cabin policies and procedures. I also understand, and will comply with, all cancellation policies and procedures.
Photo Release
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I hereby authorize and consent to the use and reproduction by SLC staff or an authorized agent or assignee of any and all photographs taken of my son for the purpose of promoting SLC without any compensation to me. All film, together with any prints, shall constitute property of SLC, solely and completely.
Medical Waiver
*
I hereby delegate authority to the Directors of the Sebago Leadership Camp (SLC) to arrange whatever medical treatment they deem necessary for him during his stay at the camp. By typing my name below, I certify that I am the parent or legal guardian of the applicant listed.
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