EmailMe Form - 2018 Boxford Park Program

Name *

First Last

Street Address: *

Town, State and Zip code: *

Cell Phone: *

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Home Phone: *

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Email Address: *

Confirm Email Address: *

Date of Birth: *

MM / DD / YYYY

Education-Year/Grade entering in Fall 2018: *

Emergency Contact Name: *

Emergency Contact Phone: *

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Reference #1 Name: *

Reference #1 contact number: *

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How do you know reference #1? *

Reference #2 Name: *

Reference #2 contact number: *

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How do you know reference #2? *

Reference #3 Name: *

Reference #3 contact number: *

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How do you know reference #3? *

Have you worked for the Boxford Park Program before? *

Yes

NO

If yes, how many years?

Did you attend the Boxford Park Program as a camper? *

Please select the following:
(If so, provide copy) *

I am CPR/ first aid certified.

I have a First Responder certification.

Neither

What position are you applying for? *

Check the activities that you would enjoy doing with the children: *

Sports games (like kickball, football, etc.)

Field Games (like relay races, water related games)

Arts and Crafts-painting, etc.

Arts and Crafts- gimp, hemp, etc.

What are your ideas of games and/or crafts that you would do with the children? *

Do you have any specials skills and interests that you would like to share with the children? (basketball, soccer, golf, tennis, drawing, singing, dancing, cheering, etc.) *

Which age group do you prefer to work with? *

Explain why you would like to work with that age group. If you would like to work with any age group, explain why as well. *

What experience do you have working with children? Be specific. *

Are you available to work all 6 weeks of Park Program? (June 26-August 2) It is mandatory to work at least 4 of the 6 weeks.

(On Wednesday July 4th, we will participate in the Town of Boxford parade.)

List any schedule conflicts you may have.

(The Boxford Park Program runs on Tuesdays, Wednesdays, and Thursdays from 9:30am-12:30pm) *

DISCUSS one example of when you acted as a positive role model for a child/children. *

DISCUSS one example of when you acted as a positive role model among your peers. *

List 3 personal strengths: *

List 3 personal weaknesses: *

Do you have any allergies or medical conditions?

No

Yes

If yes, please explain:

Acknowledgment/Disclosure Statements:
Have you received an in-school or out of school suspension in the last two years? *

No

Yes

If yes, please explain:

Have you been convicted of any crime or misdemeanor? *

No

Yes

If yes, please explain:

What is your T-shirt size? (for staff uniform ordering purposes, if you are hired) *

By typing in your first and last name, you certify that the above information is accurate and correct. Please be advised that applicants 18 years or older will have to complete a CORI check (criminal background check). A copy of driver's license needs to be provided. *

Today's Date: *

MM / DD / YYYY

Name *

First Last