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2024 Mosaic "Faces of New York" Summer Camp APPLICATION FORM -- CISV NEW YORK
This application form is the first step in the process of applying to the CISV New York "Faces of New York" Mosaic one-week summer camp for 11 and 12 year olds taking place from Sunday, August 11, 2024 through Saturday, August 17, 2024.  After we receive your application, we will send you a follow up email with next steps.

Please make sure the email address you submit below is that of the Primary Contact Parent/Legal Guardian of the child applying for camp.  This is the email we will use to send all follow up correspondence.

Now, let's get started!

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Email *
Child/Applicant's Name (First name, Last name) *
Primary Contact Parent/Legal Guardian Name (First name, Last name) *
Primary Contact Parent/Legal Guardian Phone  
(Note: We primarily communicate by email, but reserve the right to send text messages when necessary.)
 *
Applicant's Age as of August 11, 2025 *
Applicant's Date of Birth - month/date/year (XX/XX/XXXX) *
Applicant's Gender (All Welcome) *
Languages Spoken in Household *
What is your child's ethnicity?  Check all that apply. *
Required
If you selected other, please specify.
Grade in School as of September 2024 *
Name of School *
Location of School (borough of NYC, or city/state; ex. P.S. 130, Queens) *
How or from who did you hear about the Mosaic Camp? *
Have you or has anyone in your family ever participated in a CISV program?  If so, please elaborate.
Parent/Guardian Responsibilities
As a parent or guardian, we'll need you to do a few things to ensure a great experience for everyone...
--See that you and your child attend a scheduled orientation/interview session
--Submit the required CISV Health and Legal/Insurance forms by deadlines
--Read through and help your child understand the CISV Code of Conduct
--Cooperate fully with the camp directors and leaders and encourage your child to accept their authority
--Be informed about the CISV program so that you can provide a supportive atmosphere for your child
--Help your child understand that they are representing their family and community as a goodwill ambassador
--Participate in evaluations of the camp experience as requested by the chapter to help improve the experience for future campers
Family Acknowledgement
We are aware of CISV's policy for selection, preparation, training and the responsibilities of delegates and their families.  We are prepared to let our child participate in the CISV Mosaic camp program and regard our child as both physically and psychologically fit to participate.
Family Contacts & Information
Please provide accurate and detailed contact information for Parent(s) and/or Legal Guardian(s). This is the contact information which will be used to contact you when your child is at camp, if accepted.  
Parent or Legal Guardian 1 Full Name (Last name, First name) *
Street Address & Apt. No. *
City *
State *
Zip Code *
Mobile Phone *
Email Address *
Parent or Legal Guardian 2 Full Name (Last name, First name)
Street Address & Apt. No.
City
State
Zip Code
Mobile Phone
Email Address
Next Steps
Thank you for your application!  We will email you with the upcoming Info & interview session dates.  The email will come from Lauren Iossa, email: Liossacisv@gmail.com, the local CISV-NY Mosaic Committee Chair.

We welcome you and your family to experience the wonderful mission of CISV to educate and inspire action for a more just and peaceful world.  

The safety of our participants is our utmost priority. We will be following (in some cases going above and beyond) all CDC guidance and New York State Health requirements to ensure that the risk of viral transmission remains low, and so that we can focus on providing an enriching experience for all.

Please visit the website at newyork.cisvusa.org for more information about our programs, values and how to get involved.

If you have further questions about the summer camp, please email mosaicny@cisvusa.org.
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