2024 Summer CIT and LIT Application Form

Wakeman Boys & Girls Club Summer Camp CIT and LIT Application

This application should be completed by the youth. Please note the middle school LIT program is only available in Southport
Full Name*

First NameLast Name
Nickname
Date of Birth*

MonthDayYear
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent Home or Cell Phone

Area CodePhone Number
Your Cell Phone*

Area CodePhone Number
Your E-mail*
Your parents email
example@example.com
School (including town, state)
Have you ever volunteered?*

YesNo
If yes, where and what did you do?
Are you a current member of Wakeman Boys & Girls Club?*

YesNoNot sure
List 3 words that describe you (be as creative as possible. What words would your friends use to describe you:
What clubhouse would you like to volunteer this summer?

Smilow Burroughs (BridgeportSouthport (Fairfield)Madison Ave Clubhouse (Bridgeport)Type option 4
Please select the weeks that you are available, select all that apply for more options please ( program runs 8:45-3:45 Monday to Friday) For Southport, the weeks do not have to be consecutive*

June 17-June 21- FULL as of 5/21June 24th-28th (SOUTHPORT ONLY- almost full as of 5/21)July 1st-5th (NO CAMP JULY 4- almost full as of 5/21)July 8th-12th (Full at Southport as of 5/21)July 15th-19th (FULL at Southport as of 5/21)July 22nd-26th (FULL at Southport as of 5/21)July 29th-August 2nd (FULL at Southport as of 5/21)August 5th-9th- almost full as of 5/21August 12th-16th
What are your interests or talents?*

ArtsSports and FitnessEducationHealthCharacter BuildingGame Room ActivitiesCamp Wide EventsChild care and developmentJob readinessLeadership
Please list any other interests or talents you would like to include
Character References

Please include one personal reference (can be a relative) and one professional reference (teacher, coach, neighbor, clergy, etc).
1. Name of Personal Reference (can be a parent or guardian) *

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
2. Name of Professional Reference *

First NameLast Name
Title
Phone Number

Area CodePhone Number
E-mail
As a volunteer, I understand that it is my responsibility to keep track of my own service hours. I will also notify the volunteer coordinator to the best of my ability in the event of any absence.

I attest that the above information is correct. I authorize investigation of all statements contained in this profile and understand that any false information is cause for termination of my volunteer role at Wakeman. I further authorize Wakeman Boys & Girls Club to receive any criminal history record/information pertaining to me which may be on file with the local or state Criminal Justice Agencies. I understand that Wakeman is a drug free and smoke free working environment. Any use of drugs and or alcohol is cause for dismissal.
Please enter your full name below indicating the information you have submitted is correct and you agree to the above statements.*
Date

MonthDayYear
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Wakeman Boys & Girls Club Summer Camp CIT and LIT Application

Character References