Buttonwood Park Zoo - ZooCrew CIT 2015 Position: Counselor-in-Training (CIT) Description: CITs are 13 – 17 year old volunteers in our ZooCrew program. The CIT program provides experience in camp programs, public speaking, education, teamwork, and conservation. CITs will: - Get job experience while earning volunteer service hours - Assist the counselors in all aspects of camp - Help the Buttonwood Park Zoo achieve its mission of conservation and education - Be a representative of Buttonwood Park Zoo and a role model for campers - Help with all day to day operations of ZooCrew Qualifications: - Enthusiasm - Ability to work with others - Enjoy working with children - Willingness to learn - Interest in animals and conservation education - CITs must be able to commit to at least 3 full weeks of camp during the summer All applicants will be interviewed by the ZooCrew Director and must be available to assist with either Winter (2/16 – 20) or Spring (4/20 – 24) Camp as a working interview. How to Apply: Please have teen complete the entire application. Incomplete applications will not be accepted. Mail or email applications to Jen Collier. [email protected] 425 Hawthorn St New Bedford, MA 02740 Deadline: January 30, 2015 Questions? 508-991-6178 ext 31 or [email protected] Buttonwood Park Zoo - ZooCrew CIT 2015 Must be completed by applicant Name: ____________________________________________________________ Date of Birth: _____________ Address: __________________________________________________________ Home Phone: ______________________________________________________ Parent/Guardian Cell: _______________________________________________ Parent/Guardian Email: ______________________________________________ Applicant’s Cell: ____________________________________________________ Applicant’s Email: __________________________________________________ Working Interview All CITs are required to assist with either Winter or Spring Camp as a working interview. This will allow us to observe you with the campers, counselors, and other CITs. Please check with camp you are available for. If you are available for both, mark both. Hours for camp are 8:30a – 4:30p. ______ Winter Camp (2/16 – 20) ______ Spring Camp (4/20-24) Summer Camp Availability All CITs are required to work 3 weeks of the summer. Please mark ALL the weeks that you are available, even if it is more than 3. Hours for camp are 8:30a – 4:30p. _____ wk of 7/6 _____ wk of 7/27 _____ wk of 7/13 _____ wk of 8/3 _____ wk of 7/20 _____ wk of 8/10 Buttonwood Park Zoo - ZooCrew CIT 2015 Explain why you want to become a Counselor-in-Training: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Tell us about yourself…what special skills or characteristics do you have that will make you a good CIT? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Do you have any experience working with children? If yes, describe. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Is there anything else we should know about you? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ (If there is not enough room, feel free to write on the back) Buttonwood Park Zoological Society Volunteer Information and Risk Release Parent or Guardian: Please print the following information and return it to the Zoo two days prior to volunteering. This form must be completed prior to volunteering at the Zoo. This risk and release waiver covers all volunteer events from January 1, 2015 to December 31, 2015. Volunteer name:________________________ Volunteer telephone:________________ Emergency contact information Name__________________________________ Relationship__________Telephone_________________ Name__________________________________ Relationship__________Telephone_________________ Please list any allergies, medications, and personal or health concerns:___________________________ _____________________________________________________________________________________ Release: In consideration of being allowed to participate in volunteer activities at the Zoo at Buttonwood Park, I, (full name) _______________________________________________ of ________________________________ hereby release and discharge the City of New Bedford and the Buttonwood Park Zoological Society, Inc., their agents, officers, officials, employees and representatives from all claims, demands, actions, judgments, and executions which I ever had, or now have, or may have or which my heirs, executors, administrators, or assigns may have or claim to have against the City of New Bedford or the BPZS, Inc., its agents, officers, officials, employees and representatives for all personal injuries and property damage known or unknown caused by or arising out of the above described activity. I further waive any claim to compensation or indemnification from the City of New Bedford or BPZS, Inc. for or arising out of the activity above. I understand and acknowledge that I am engaging in this activity as a volunteer, at my own request and risk and that I am not a City of New Bedford or BPZS, Inc. employee, agent, official, officer or representative and am not entitled to any compensation, benefit or insurance coverage from the City or BPZS, Inc., nor will I claim any from the City or BPZS, Inc. I further agree to act responsibly at all times while on the premises and to follow the direction of Zoo and BPZS, Inc. staff. I have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance. In witness whereof, I have executed this release at ________________________________ on (Today’s Date) _________________, 2014. _____________________________________ ________________________________________________ Witness Name of volunteer (please print) __________________________________________ Signature of Volunteer/Signature of Parent or Legal Guardian for volunteers under age 18 (required) ______________________________________________________ Name of Parent or Guardian, if applicable (please print) _______________________________________________________ Volunteer’s Full Address _______________________________________________________
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