2026 Clipper Day Camp - Counselor In Training Application

Name Name First Last
What grade are you entering in the fall?
Are you able to attend mandatory CIT Training on 6/19/2026?

Are you able to attend mandatory CIT Training on 6/19/2026? Yes No
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email

Confirm Email Address
T-Shirt Size

T-Shirt Size Small Medium Large X-Large 2X
List any current certifications you have acquired (Lifeguard, CPR, First Aid, Babysitting, EMT, Bus Driver, etc..)
List all job positions you have held (include dates of employment along with supervisor's name, phone number, and email address). Write "None" if this would be your first job.
SCHEDULING SECTION
Please select any/all sessions you are available for (You will be assigned to ONE session only):

Please select any/all sessions you are available for (You will be assigned to ONE session only): Session 1: 6/24-6/26, 6/29-7/3 9:00-3:00 ($55 registration fee) Session 2: 7/6-7/10, 7/13-7/17, 9:00-3:00 ($75 registration fee) Session 3: 7/20-7/24, 7/27-7/31, 9:00-3:00 ($75 registration fee) Session 4: 8/3-8/7, 8/10-8/14, 9:00-3:00 ($75 registration fee)

Choose all that apply

List the sessions in order of your preference
	Session 1	Session 2	Session 3	Session 4
First Choice	First ChoiceSession 1	First ChoiceSession 2	First ChoiceSession 3	First ChoiceSession 4
Second Choice	Second ChoiceSession 1	Second ChoiceSession 2	Second ChoiceSession 3	Second ChoiceSession 4
Third Choice	Third ChoiceSession 1	Third ChoiceSession 2	Third ChoiceSession 3	Third ChoiceSession 4
Forth Choice	Forth ChoiceSession 1	Forth ChoiceSession 2	Forth ChoiceSession 3	Forth ChoiceSession 4

REFERENCE INFORMATION
Reference #1 Name Reference #1 Name First Last
Relationship
Phone Phone - ### - ### ####
Email
Reference #2 Name Reference #2 Name First Last
Relationship
Phone Phone - ### - ### ####
Email
Reference #3 Name Reference #3 Name First Last
Relationship
Phone Phone - ### - ### ####
Email
SCHOOL INFORMATION
High School Name
Year of graduation or expected graduation
Please list any special interests or skills you have that would help you to be an effective counselor in training.
Tell us about any experience you have working or volunteering with children
There are many ways to earn community service hours. Why did you choose to complete yours through the CIT program at Clipper Day Camp with Yarmouth Community Services?
What do you think children gain from being part of youth programs or sports?
Town of Yarmouth / Yarmouth Community Services Background Check Authorization
By singing below I understand that in order to assess my qualifications for the position of camp counselor, a full criminal background investigation is necessary. I, therefore, authorize the Town of Yarmouth/Yarmouth Community Services to conduct an investigation in order to obtain information concerning my criminal background.

I understand that a consumer report may be prepared summarizing the above information. I may request a copy of any report that is prepared regarding me from the consumer reporting agency and may also request the nature and substance of all information about me contained in the files of the consumer-reporting agency. I understand that proper identification will be required and that I should direct my request to:

Equifax Credit Information Services, Inc
P.O. Box 740241
Atlanta, GA 30374

I hereby release any individual, entity and the municipality from all claims of liabilities that might arise from the inquiry into or disclosure of such information, including claims under any federal, state, or local civil rights law and any claims for defamation or invasion of privacy.

All the information and materials I have provided to the Town of Yarmouth as part of the employment process are accurate and truthful. I realize that providing the municipality with false information or intentionally withholding relevant information regarding my application may be grounds for dismissal.
Do you agree to the request stated above?

Do you agree to the request stated above? Yes, I agree No, I do not agree
Your Full Legal Name Your Full Legal Name First Middle Last
Date of Birth Date of Birth / MM / DD YYYY
Certificate of Applicant

Read Carefully Before Signing - I hereby certify that all statements in this application are true and complete and that any misstatement or omission of material facts may subject me to disqualification or dismissal.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

2026 Clipper Day Camp - Counselor In Training Application

2026 Clipper Day Camp - Counselor In Training Application

SCHEDULING SECTION

REFERENCE INFORMATION

SCHOOL INFORMATION

Town of Yarmouth / Yarmouth Community Services Background Check Authorization

Certificate of Applicant