2020 CISV New York Mosaic "Faces of New York" Camp APPLICATION FORM
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 taking place from Sunday, August 9 through Saturday August 15, 2020. After we receive your application, we will send you a follow up email with next steps and the date of our Info & Interview Session for all Applicants.

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!
Email address *
Child/Applicant's Name (First name, Last name) *
Your answer
Primary Contact Parent/Legal Guardian Name (First name, Last name) *
Your answer
Primary Contact Parent/Legal Guardian Phone *
Your answer
Applicant's Age as of August 9, 2020 *
Your answer
Applicant's Date of Birth - month/date/year (XX/XX/XXXX) *
Your answer
Applicant's Gender (All Welcome)
Your answer
Grade in School as of September 2020 *
Your answer
Name of School *
Your answer
Location of School (borough of NYC, or city/state; ex. P.S. 130, Queens) *
Your answer
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) *
Your answer
Street Address & Apt. No. *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Phone *
Your answer
Alternate Phone
Your answer
Email Address *
Your answer
Parent or Legal Guardian 2 Full Name (Last name, First name)
Your answer
Street Address & Apt. No.
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Primary Phone
Your answer
Alternate Phone
Your answer
Email Address
Your answer
Next Steps
Thank you for your application! We will email you with the upcoming Info & interview session date. 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.

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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