Western Plains District » Western Plains District Counselor in Training Application

Thank you for your interest in serving as a counselor in training (CIT). Please be aware of our current guidelines. In order to serve as a CIT you must be at least 14 years old AND at least 3 years older than the oldest camper of the session in which you wish to serve.

I confirm that I am at least 14 years old and 3 years older than the oldest camper of the session I wish to serve. *

Prior to completing this CIT registration form, you will need the following:

Permission from the director(s) to serve as a CIT for the camp session(s) you have chosen (Check the camp websites for director name and email address)
Completed health form to upload (or you may send by mail to the director if you prefer no later than 2 weeks prior to start of camp). As you are under the age of 18, you should submit the CAMPER HEALTH FORM.
Health insurance card to upload (front and back – a picture is fine)
Immunization record to upload (a picture is fine)
Driver’s license to upload – or other form of identification (a picture is fine)
Confirm with the district office that you have 3 current reference forms on file (620-241-4240; office@wpcob.org). Reference forms are good for 10 years and cannot be from members of your family. If you do not have current forms on file, you may give this link to your references, which, when completed, will be automatically submitted to the district office.
Parental awareness of your intent to volunteer as a CIT.

Camp Colorado CITs will need to complete the Standard Precautions Training (more info available here) and have your completion certificate available to upload. This training is required each year.

I have completed the above checklist and am ready to upload and provide all of the documents listed while completing my application. *

Applicant Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Birthdate *

Gender *

Email *

Confirm Email

Cell Phone

Home Phone *

Name of Parent/Guardian *

First

Last

Home Congregation *

Dietary Restrictions

Camp Choices

Choice of Camp *

Camp Colorado
Camp Mt. Hermon

Emergency Contact Information

Name *

First

Last

Relationship to you *

Home Phone *

Cell Phone *

Work Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

School Information

Name of School *

Current year in school *

Experience

Experiences with Youth Work or Childcare *

Experiences with Camping/Outdoor Ministries *

Religious Background *

Why do you wish to be a counselor in training? *

References

Camps are required to keep reference forms from three (3) references on file for you. Reference forms are good for 10 years. Forms should come from persons who know you well and are not members of your family. Your application will not be complete until these forms have been received. The online reference form can be found here.

By typing my initials below, I am affirming that I have confirmed with the Western Plains District office (620-241-4240; office@wpcob.org) that I have 3 reference forms on file, and I understand that my application is not complete without the reference forms on file.

Initials *

Health Information

All staff are required to have a completed health form on file. As you are under the age of 18, you should submit the camper health form. Health forms are good for 1 year and can be found here or on the camps’ websites: www.campcolorado.org and www.campmounthermon.org. You can upload the Health Form below or mail it to your director.

Please also upload a copy of your health insurance card (unless you do not have health insurance) and immunization record below.

All staff are also required to have some form of identifcation on file. There is a space for you to upload either a driver’s license or other form of ID below.

Health Form

Click or drag files to this area to upload. You can upload up to 4 files.

A picture of your completed Health Form is an acceptable format.

Health Insurance card

Click or drag files to this area to upload. You can upload up to 2 files.

Front & back – a picture is an acceptable format.

Immunization Record

Click or drag files to this area to upload. You can upload up to 2 files.

A picture is an acceptable format.

Identification

Click or drag files to this area to upload. You can upload up to 2 files.

Driver’s license or other form of ID (front & back) – a picture is an acceptable format.

COVID 19

By typing my initials below, I understand that campers and staff are expected to follow COVID 19 health guidelines. Guidelines for the 2023 camping season will be posted on the camp websites by 5/15/2023.

Initials *

Applicant's Statement

By typing my initials below, I certify that I have the director’s permission to serve as a CIT at the camp I have selected above.

Initials *

By typing my full name below, I agree to the Applicant’s Statement that follows:

I certify that the information contained on this application is correct to the best of my knowledge and understand that any omission or erroneous information is grounds for dismissal.
I agree to support and uphold the mission of the Western Plains District Camping Program.
I agree to operate under the policies and procedures of the camp(s) where I will be on staff.
I authorize Camp Colorado and/or Camp Mt. Hermon and the Western Plains District to photograph me and to use such photographs for the purpose of camp promotion, publicity or historical record.

Signature *

First

Last

Parental Consent

By typing my full name below, I acknowledge that, as parent/legal guardian, I am aware of my child’s/ward’s intent to volunteer at Camp Colorado or Camp Mt. Hermon for the 2023 camping season.

Parent/Guardian Signature *

First

Last