CIT Application

General Information

First Name*

Last Name*

Parent's Full Name*

Email*

Phone/VP Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth*

How did you learn about Bridging Hands Camps?*

Are you a US citizen?*

Yes
No

Are you ...?*

Deaf
Hard of Hearing
CODA
Hearing

Gender*

Are you fluent in ASL?*

Yes
No

Primary communication button*

ASL
Cued Speech
Spoken English

Important Information From Parents

Do we have your permission to send your child to the nearest Urgent Care or Emergency Room if an emergency arises?*

Yes
No

Does your child have any medical allergies?*

Yes
No

If so, what type?

Any medications?*

Yes
No

What type of medications?

Name	Frequency given	Dosage

Food Allergies?*

Yes
No

Type of Food Allergies

Does your child need any specific accommodations (physical/medical/cognitive)?*

Yes
No

Type of Specific Accommodations

Type	Accommodations needed

Any diet restrictions?*

Yes
No

Type of Diet Restrictions

Photo and Video Waiver

I grant permission to Bridging Hands Camps, Inc., its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at Bridging Hands Camps, Inc. for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium. I hereby release Bridging Hands Camps, Inc. and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.

Please read and agree*

Yes

Relevant Experience

Which statement best describes your leadership style with youth and among peers?*

I like to lead by example, I'm not a vocal leader but I will speak up if necessary.
I like to take charge and run the show. My co-leader can have some input, but I usually know how I want to do things right from the start.
I'm an authoritative leader, I work better without a co-leader and I have no problem keeping everyone in line.
I think of myself as a facilitator, I put everyone in a position to succeed and the rest is up to them.
I'm an active leader, if someone has a hard time climbing a route I'll get up on the wall and show them how it's done.

Camp Experience*

Please describe your total experience with overnight camps. Personal experience includes recreational experience, or time spent as a participant in an organized activity such as a outdoor program or with organizations such as NOLS, Outward Bound, or at a summer camp. Professional experience includes time spent instructing other participants as a designated leader or co-leader of an organized program.

Do you have a CPR Certification?*

Yes
No

Essay Questions

What is your greatest motivation for working in the outdoors with youth?*

How do you usually respond in fast-paced or stressful situations?*

What steps do you take typically take when you are faced with a problem or have a difficult decision to make?*

What fruit or vegetable best describes your personality?*

Professional References

Please list three professional references.

References*

First Name	Last Name	Relationship	Email	Phone Number

Payment

Do you want to make a full payment or set up a payment plan?*

CIT Registration Fee

Price:

Payment Plan

Price:

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total

$0.00

Ready to Get to Work?