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Name:______________________________________________       Grade Entering:   8th     9th

Mailing Address:_______________________________________________________________

Home Phone:_____________________________ Cell Phone:__________________________

E-Mail Address:_______________________________________________________________

Emergency Contact:__________________________________Phone:____________________

Summer Fun CIT hours are 9:00am to 12:00pm.  This is a voluntary position.

Please indicate 1st, 2nd & 3rd choice.

_____ Week 1    July 7th-11th                           
_____ Week 2    July 14th-18th                          
_____ Week 3    July21st- 25th                          
_______   Week 4        July 28th-August 1st                            
_____   Week 5  August 4th-August 8th                                    

Why do you want to be a CIT?

Past experience (include past CIT experience and any special qualifications):

As a counselor in training, I understand that part of my responsibility is to accept direction from senior staff and the program director. I understand that I may not be offered the week or position I have applied for, and have the right to refuse that position which is offered to me. I also understand that I am not guaranteed a volunteer position as a CIT by completing this application.

Signature (CIT):  ________________________________________ T-shirt size: __________________
Signature (Parent/Guardian):  __________________________________________________________

Town of Rutland 250 Main Street, Rutland, MA 01543   Disclaimer
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