Beach Destinations
and Directions

APPLICATION FOR
COUNSELOR IN TRAINING PROGRAM

ORCA SUMMER CAMP
11 Miramar Avenue
San Rafael, CA  94901
805-448-3308

Please print this form and mail to Orca Summer Camp.

The CIT program at Orca Summer Camp is for high school students volunteering for community service hours to fulfill graduation requirements. It is the CIT’s responsibility to have the camp director sign documentation needed by the school verifying community service hours.
NAME AGE
Weeks Available
Email Address
Current School
School in Fall
Parents Names
Address
City
State, ZIP
Home Phone
Work Phone CIT Cell/Mobile
Name of 1 Reference Phone
Relationship to you
Work Phone Cell/Mobile
Required - Please list any work or previous community service:
Required - Please write a short statement about how your skills and experience may contribute to our camp.

Parents approval for student application:

Parent/Guardian Signature___________________________________________

Date____________________

Applicant Signature___________________________________________

Date____________________

Rob Harrington, 11 Miramar Avenue, San Rafael, CA 94901

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