CIT Application Form

Address*

Applicant's Cell Phone Number*
Parent's Cell Phone Number
Applicant's E-mail*
Parent's E-mail
Grade Entering Fall 2026
School NEXT year 2026/2027
List dates you're available this summer
Are you CPR certified?

YesNo
Have you ever had a school suspension or expulsion? If so please provide history and details.
Have you ever had a delinquency adjudication? If so please provide history and details.
Have you ever been convicted of an assault or other offense? If so please provide history and details.
Returning counselors need not fill out the following info and can skip to the signature
Describe all previous experience that you have had with children ages 5-13. Specify the role that you played, the ages of the children, and how often you helped care for them.
Share any skills, talents, and certifications you have that could be utilized in our camp.
Reference #1
Name (Reference #1)
First Name Last Name
Phone Number

Area Code Phone Number
Relationship to applicant
Reference #2
Name (Reference #2)
First Name Last Name
Phone Number

Area Code Phone Number
Relationship to applicant
Signature
Date of Signature

Month Day Year
Should be Empty:

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Camp Gan Izzy CIT Application Form