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Counselor Name *
Counselor Email Address *
Counselor Cell Phone:
Home Phone:
Parent Name: *
Parent Email Address: *
Parent Phone Number: *
Home Address: *
City: *
State: *
Zipcode: *
Date of Birth: *
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Shirt Size: *
School: *
Grade as of Fall 2020 *
I have been involved with Sebago before as a *
Please write a 500 word job description of what makes a great Sebago Leadership Camp Senior or Junior Counselor.
Electronic Devices Policy
Preferably, electronic devices (smartphones, iPads, and the like) will be left at home. The reason for leaving these types of devices at home is to foster a tone of camaraderie and friendship. Unfortunately, at times, electronic devices have the opposite effect—tending to isolate people and be an obstacle to conversation.

*If you do bring one of these devices, the staff will collect them upon arrival. There will be a couple of times during the camp that you will have access to them so you may respond to important messages or calls. (Coverage, however, may be quite limited.)

Parents may reach participants at any time by calling Raymond Le Grand at 972-904-1002 or JP Lechner at 202-733-0771.
List any pertinent medical information (allergies, medications, dietary requirements, etc.)
Insurance Company
Insurance Company Phone #
Policy Number
Insurance Group Number (if applicable):
Electronic Signature of Parent or Legal Guardian: *
Photo Release: I hereby authorize and consent to the use and reproduction by SLC staff or an authorized agent or assignee of any and all photographs taken of my son for the purpose of promoting SLC without any compensation to me. All film, together with any prints, shall constitute property of SLC, solely and completely. Liability Waiver: I hereby give permission for our son to participate in all activities conducted by SLC. We agree to hold the directors and staff harmless from any liability to anyone on account of any injuries to our son. I understand that SLC cannot be responsible for lost or broken items.I understand my son will comply with all cabin policies and procedures. I also understand, and will comply with, all cancellation policies and procedures. Medical Release: I hereby delegate authority to the Directors of the Sebago Leadership Camp (SLC) to arrange whatever medical treatment they deem necessary for him during his stay at the camp. By typing my name below, I certify that I am the parent or legal guardian of the applicant listed.
Payment Policy, Fees, and Conditions of Application
Enrollment: To enroll your son in the CIT program, we must receive your application and the $100 deposit. The remaining balance is due on or before June 1st. If cancellation occurs after June 1st, all payments will be forfeited unless space can be filled from our waiting list. If space is filled, all money, excluding the $100 deposit, will be refunded.

Payment: Mail all checks to:
Sebago CIT Program
481 Hammond Street
Chestnut Hill, MA 02467
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