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Junior Counselor Internship (JCI) Application 2017
Thank you for your interest in the summer Jr. Counselor Internship (JCI) at the Douglas-Hart Nature Center.
Please read the Junior Counselor Internship program requirements (brochure) before applying.
Are you 18 years of age or older? (You must be at least 13 to be a JCI)
Grade completed in school:
Phone Numbers: List ALL numbers by which we can reach you or your parents (if under 18).
Your personal cell:
Parent's Cell (list full name):
Parent's Cell (list full name):
Other (please describe):
Check the boxes of the method(s) you prefer to be contacted by:
Allergies, asthma, and other medical conditions we should be aware of:
Emergency Contact Phone Number:
Environmental Education Interests & Skills
Check all of the following statements that describe your JCI expereience level:
This will be my first volunteer experience at Douglas-Hart.
I have volunteered at Douglas-Hart before.
I have completed this internship before.
How did you hear about the Junior Counselor Internships? (Check all that apply)
From my previous invovlement with the JCI program.
From a staff member at Douglas-Hart.
From a teacher or school counselor.
From a friend who recommended it.
If you answered "from a friend," "from a teacher," or "other," please list their name or explain here:
Current Occupation (optional):
Future Career Goal (optional):
Education Background (i.e. high school attended):
Do you have any experience in previous volunteer roles or in working with kids? Please describe in brief.
Please describe in your own words why you would like to complete the Jr. Counselor Internship this summer:
Declaration of History
Are there any past or pending criminal charges against you?
Have you ever been convicted for a felony offense?
Have you ever been charged with child abuse or neglect?
Have you ever been charged with a sexual crime?
Is there anything else that we should know about your history or health?
Use this space to explain any questions you answered "YES" to. If you would rather discuss your answer in person, write "see me." For ALL criminal charges, please list the city and state, or county.
To complete this internship, you will need to complete all of the following requirements:
Attend one of the dates for Workshop A.
Attend one of the dates for Workshop B.
Accumulate at least 30 hours of service in the program.
We do not expect you to schedule every week of the summer.
Your 30-hour goal will include your training workshops, and can be achieved with as few as 2 summer camps! However, there is no maximum and you are encouraged to continue your experience beyond 30 hours. We do recommend spreading your efforts over the summer, to gain the most experience with different camp leaders, age groups, and themes.
What you can Expect for Scheduling:
Each of Douglas-Hart’s many summer day camps seek the help of
Returning JCI’s get the privilege of priority sign-up. They may let the coordinator know their camp choices at any time, but must submit priority sign-up requests BEFORE the first date of Workshop A.
New JCI’s will get to take turns signing up for camps when they attend Workshop A, or after.
After Workshop A, all remaining JCI spots will fill on a first-come, first-served basis.
When you sign up for a camp, you are taking on a responsibility for those dates. Write down your camp dates & shifts. Make sure your parents and/or transportation means are aware of them as well.
You should be present for each day of your camps. You may sign up for a camp only if you know you can attend
every day of that camp
(or all but
day). You must notify the coordinator AND your camp leader ASAP if you will have a day of absence.
NO CALL, NO SHOWS will not be allowed in the program. If you miss more than one shift without giving advanced notice, you may be ineligible to continue in the program.
REMEMBER to arrive to camp 15 minutes
its start to meet with the camp leader. Remember to stay 15 minutes
camp ends to assist and consult with the camp leader.
Your Predicted Availability:
Please use this section of your application to give us an idea of your availability this summer.
Do your best to estimate your availability for now. You will not be committed to this schedule yet.
Training Workshops (required)
Workshop A - select a date
Saturday, May 27, 2017
Saturday, June 3, 2017
Workshop A - select a time (lunch is included for both times)
10am-3pm - required for new JCI's
12pm-3pm - required for returning JCI's
Workshop B - select a date
Friday, June 9, 10am-12pm
Friday, June 16, 2pm-4pm
Social Events (optional)
Check the social events you are interested in attending:
JCI Challenge Fun Day! (Sat., July 1, 1-4pm)
Reward Field Trip to Scovill Zoo! (Sat., July 29, 9am-3pm)
End-of-the-Summer Family Potluck & Open House (Sat., Aug. 12, 12-2pm)
I verify that all information in this application is correct and complete.
I understand that there are risks to working on the Douglas-Hart Nature Center property. I will exercise reasonable safety precautions and will assume all liability for my own accidents and injuries while volunteering my time.
While volunteering, I will model good behaviors and language.
I will adhere by Douglas-Hart Nature Center rules and respectfully represent the facility and staff when on and off the site.
It is my responsibility to arrange my transportation. In the interest of helping DHNC, I will contact staff if I am going to be late or not coming.
E-signature of volunteer
E-signature of parent or guardian (if volunteer is under 18).
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