WWW.NECYSC.ORG

CCYSENNew EnglandChinese YouthSummer Camp

NECYSC is a bilingual campAll are welcome!

Theme of 2018 - Ancient Chinese InventionPaper making, book making, movable type printing,

firecracker, cloth dyeing, abacus, and compassFolk Sports, Folk Dance, Chinese Instruments, Cooking, Field Trip are also available

Day Program - Ages 6-10Overnight Program - Ages 10-14

ExplorAsian Program - Ages 14-18

Regis College @ 235 Wellesley Street, Weston MA 02493

July 29 - August 4, 2018(Registration starts February 1, 2018)

2018營隊的主題是中國的科學發明(造紙, 製作書本, 拓印, 火藥, 染布, 算盤, 指南針)另外有民俗體育舞蹈, 中國樂器, 烹飪, 野外教學課程

中英文雙語教學的中華文化營

WWW.NECYSC.ORG

DIRECTOR@NECYSC.ORG

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NECYSC Counselor Application 2018

General Information

Camp Location: Regis College, 235 Wellesley St., Weston, MA 02493

Age Requirement: High School graduate or 18 years old (by August 2018)

Timeline:

January 9

Counselor Application starts

February 1

Email Applications due at 11:59pm

February 1

Online registration is open

Download other camp forms and mail into PO box from www.necysc.org

March 9 - 11

Counselor interviews

July 27

Counselor training

July 28

Staff training

July 29 - August 4

Camp session

Camp Overview

The New England Chinese Youth Summer Camp (NECYSC) started in 1987. NECYSC is a non-profit

organization whose goal is to bring together youth interested in Chinese culture and foster a sense of

community. We are looking for dedicated, responsible, and passionate Counselors to lead campers in daily

activities. Counselors interact extensively, cooperatively, and creatively with each other, with CITs, and

with other camp staff to hone their teaching, leading, and communication skills.

Counselor Job Description

As a counselor, you will:

● Lead a group in either the Day or Overnight program. Day staff works with campers of ages 6-10 and

overnight staff works with campers of ages 10-14. Along with two CITs, you will lead a group of around

twenty campers through activities and classes as well as build a sense of community within the group.

Day campers leave at 5:30pm and Overnight campers attend camp-wide activities during the night.

● Plan an evening activity. You will work with other counselors to coordinate, organize, and implement

one of the evening activities for Overnight campers, which include the Carnival, CIT Dress-Up, Movie

Night, Talent Show, and the Dance.

● Train CITs. You will hold a group meeting every night with your co-staff to review the day, prepare for

the next, and give both compliments and criticisms. You will mentor your CITs and help them improve

their leadership abilities.

● Develop leadership skills. During camp, you’ll have to think on your feet, take charge of tough

situations, and mentor other staff members. As a role model to both campers and other staff, you’ll

have several opportunities to improve your leadership skills.

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Application

Please send an email to director@necysc.org and headcounselors@necysc.org with an attached

PDF document containing the following information:

Applicant Information: (please include in body of email AND application)

Name

Gender

Home Address

Current School

Date of Birth

Telephone (most easily reached)

Personal E-mail

Last six digits of social security number (for CORI/SORI check)

Please answer the following questions:

1. What qualities make you a strong leader, and how do you embody these qualities?

2. What do you hope to gain from this experience?

3. Counselors organize one or two 1-hour activities for Counselor Time. Previous Counselor

Time activities have included tie-dyeing apparel, decorating picture frames, making ice

cream, and doing a scavenger hunt. Plan a Counselor Time activity (specify the age group

you have in mind).

4. What age group and program (Day/Overnight) would you prefer to work with and why?

New Counselors

5. What about this role will challenge you?

Returning Counselors

5. What is one challenge that you faced in previous years, and what did you learn from it?

Think about any advice you would pass on to your CITs—what do you wish you had known

for your first year as a Counselor?

Note: The counselor selection process is highly selective due to the limited number of spots and

the competitive applicant pool. We also encourage you to apply as a Residential Advisor for

ExplorAsian, an NECYSC program for high school students. You may apply for both the RA

position and the counselor position. If you are interested in being an RA for ExplorAsian, please

email explorasian@necysc.org.

Other

This is a paid position. Acceptance is contingent on a CORI/SORI check. Counselors must stay on campus all week. Questions? Contact headcounselors@necysc.org

Please be prepared to schedule an interview on March 9th (Friday Afternoon/Night).

Based on your application, we will contact you if we would like to proceed with an interview. If

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contacted, the interview is required to be considered. Interviews will be conducted at the following

address:

GBCCA 437 Cherry Street West Newton, MA 02465

Have you submitted everything?

✓ Applicant information and supplemental questions (in PDF format) as detailed above emailed to

director@necysc.org and headcounselors@necysc.org

✓ Counselor/CIT/Camper Online Registration completed online at www.necysc.org (opens February 1)

✓ Mail required Forms to NECYSC, P. O. Box 615, Weston, MA, 02493:

Health Form B (required)

Medication Permission Slip

CORI/SORI (required if over 18)

Note: You may check your online registration status at www.necysc.org/status/.

Application ID

NECYSC HEALTH FORM B

Day Overnight ExplorAsian CIT Counselor Staff

(To be filled out by Camper’s Physician or substituted with Physician’s

Health Report Form dated within 1 year of camp session. Please write

registration ID on top of Physicians report)

PHYSICAL EXAMINATION INFORMATION

Patient’s Name:

Date of Birth (mm/dd/yy): (Last, First)

Height: Weight: Blood Pressure:

Skin Eyes Nose

Mouth Teeth Neck

Throat Lungs Heart

Abdomen Ano-genital Spine

Lower Extremities Upper extremities Cranial Nerve

Does the Patient Allergy medication(s)

Have any allergies? Yes No Dose, frequency: Is

the patient taking

other medications? Yes No If yes, describe:

Does patient wear: Glasses/ Contacts/ Hearing Aid (Check all that apply)

Immunizations: DPT Polio MMR H1B Hep B Other Vaccines

Original dates: 1 1 1 1 1

2 2 2 2 2

3 3 3 3

4

Booster dates: 4 4

5 5

LAB TESTS Dates: Results:

Tuberculin test/PPD (if patient has traveled outside of country within past year)

Hgb/Hct (if tested):

Family medical history:

Patient medical history (operations, serious injuries/illnesses):

Date of Physical Examination: Physician:

Health Center Name:

Address: Phone:

Physician Signature: Date: Please notify the camp if the camper is exposed to any communicable diseases 3 weeks prior to his/her arrival at

camp.

Parents:

If any medication is needed, please also fill out the medication permission slip.

Child’s Physician: Please Complete Camper Health Form (B)

Revision:2017

Application ID:

MEDICATION PERMISSION SLIP

Day Overnight ExplorAsian CIT Counselor Staff

NAME (LAST, FIRST): DATE OF BIRTH (mm/dd/yy):

If your child uses an Epi Pen or inhaler, please bring two: one for the group Counselor and one for the

Camp Nurse.

Medication:

Dose: Frequency:

Route:

Medication:

Dose: Frequency:

Route:

Medication:

Dose: Frequency:

Route:

NO MEDICATION WILL BE ADMINISTERED WITHOUT A SIGNED PERMISSION SLIP

Over the Counter Medication Must be in the original container

Prescription Medication Must be in original container with pharmacy name, medication, dosage,

how often to administer, route and prescribing doctor.

I, (parent/guardian)

give permission for qualified personnel under the direction of the

New England Chinese Youth Summer Camp (NECYSC) to administer the medications listed above.

Parent/Guardian Signature: Date:

revision: 2017

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Application ID

Criminal Offender Record Information (CORI)

Acknowledgement Form

New England Chinese Youth Summer Camp (NECYSC) is registered under the provisions of M.G.L. c.6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, current licensees, and applicants for the rental or lease of housing.

As a prospective or current employee, subcontractor, volunteer, license applicant, current licensee, or applicant for the rental or lease of housing, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to NECYSC to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing NECYSC with written notice of my intent to withdraw consent to a CORI check.

FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY:

The Public Relations Committee, on behalf of NECYSC, may conduct subsequent CORI checks within one year of the date

this Form was signed by me, provided, however, that NECYSC must first provide me with written notice of this check.

By signing below, I provide my consent to a CORI check and affirm that the information provided on Page 2 of this

Acknowledgement Form is true and accurate.

Signature of CORI Subject Date

To be used by organizations conducting CORI checks for employment, volunteer, subcontractor, licensing, and housing purposes.

2

* First Name: Middle Initial:

* Last Name: Suffix (Jr., Sr., etc.):

Former Last Name 1:

Former Last Name 2:

Former Last Name 3:

Former Last Name 4:

* Date of Birth (MM/DD/YYYY): Place of Birth:

* Last SIX digits of Social Security Number: ‐‐ □ No Social Security Number

Sex: Height: ft. in. Eye Color: Race:

Driver’s License or ID Number: State of Issue:

Father’s Full Name:

Mother’s Full Name:

* Street Address:

Apt. # or Suite: *City: *State: *Zip:

The above information was verified by reviewing the following form(s) of government‐issued identification:

Verified by:

Sandra Wong

Print Name of Verifying Employee

On File Summer Camp 2018

Signature of Verifying Employee Date

SUBJECT INFORMATION Please complete this section using the information of the person whose CORI you are requesting.

The fields marked with an asterisk (*) are required fields.

Current Address

SUBJECT VERIFICATION

Use of legal name as shown in government issued ID is a MUST.

Application ID

Commonwealth of Massachusetts Sex Offender Registry Board

M.G.L. c. 6, § 178I REQUEST FOR SEX OFFENDER REGISTRY INFORMATION

All requests for sex offender information must be made on

this form and mailed to the Sex Offender Registry Board,

Attn: SORI Coordinator, P.O. Box 4547, Salem, MA 01970,

along with a self-addressed stamped envelope. The Board will

provide a report that includes the following information: whether the

person identified is a sex offender with an obligation to register, the

offense(s) for which the offender was convicted or adjudicated, and the

date(s) of the conviction(s) or adjudication(s). Please be advised that

the law only permits the public to receive information on sex offenders

required to register and finally classified by the Board as a level 2

(moderate risk) or level 3 (high risk) offender. Therefore, information

is not available to the public if the identified individual is a level 1 (low

risk) offender or if he/she has not yet been finally classified by the

Board.

All requests shall be recorded and kept confidential, except to

assist or defend in a criminal prosecution.

Sandra Wong N/A Requestor’s name: Date of birth:

Organization name: (if any) New England Chinese Youth Summer Camp

Address: see www.necysc.org for mailing information Telephone number: ( )

pr@necysc.org

I swear under the pains and penalties of perjury that I am the above-named person, at least 18 years of age, and I am requesting information

for my own protection, the protection of a child under 18 years of age, or for the protection of another person for whom I have responsibility,

care or custody. Signature on file with NECYSC Summer Camp 2018

Requestor’s signature: Date:

I hereby request that the following information be used to determine whether the identified individual is a sex offender required to register in Massachusetts.

Subject’s LAST NAME:

Subject’s FIRST NAME::

Subject’s MIDDLE INITIAL:

Date of birth or approximate age: / /

M M D D Y Y Y Y AGE

Address (PRINT):

Personal identifying characteristics:

Sex: Race: Height: Weight: Eye Color: Hair Color:

Other information (e.g. license plate number, parents’ names, etc.):

If additional information is needed, please contact the Requestor at the telephone number above.

**********WARNING**********

SEX OFFENDER REGISTRY INFORMATION SHALL NOT BE USED TO COMMIT A CRIME OR TO ENGAGE IN ILLEGAL DISCRIMINATION OR

HARASSMENT OF AN OFFENDER. ANY PERSON WHO USES INFORMATION DISCLOSED PURSUANT TO M.G.L. C. 6, §§ 178C – 178Q FOR SUCH PURPOSES

SHALL BE PUNISHED BY NOT MORE THAN TWO AND ONE HALF (2 ½) YEARS IN A HOUSE OF CORRECTION OR BY A FINE OF NOT MORE

THAN ONE THOUSAND DOLLARS ($1000.00) OR BOTH (M.G.L. C. 6, § 178N). IN ADDITION, ANY PERSON WHO USES REGISTRY INFORMATION TO

THREATEN TO COMMIT A CRIME MAY BE PUNISHED BY A FINE OF NOT MORE THAN ONE HUNDRED DOLLARS ($100.00) OR BY IMPRISONMENT FOR

NOT MORE THAN SIX (6) MONTHS ( M.G.L. C. 275, § 4).

Completing information below the “Date of birth or approximate age” is optional.

Use of legal name as shown in government issued ID is a MUST. SOR Form 4 (05/11)

SORB USE ONLY