JUNIOR LEADER DEVELOPMENT PROGRAM APPLICATION

SECURE ONLINE APPLICATION

Thank you for your interest in developing your skills in our Junior Leader Program. Team Leaders will be reviewing all signed applications delivered to our office and will then contact applicants they wish to interview for the positions available ( the majority of positions are available for Spring and Summer).

PLEASE NOTE: It is important that applicants complete this form themselves in their own words. Of course, the form must be shown to parents so the parent(s) can complete the PARENT / GUARDIAN APPROVAL, RELEASE FORM & ACKNOWLEDGEMENT OF RISK section at the end.

BEFORE YOU BEGIN THIS APPLICATION FORM...

REFRESH your screen by pressing the "F5" button on your computer keyboard. This will update your browser and ensure you are using the most current version of this form.

**PLEASE NOTE: All applicants must be
14 - 17 years old for this program.**

AFTER YOU COMPLETE this online application form, you will get a final copy in your email (almost immediately) with all the questions on this application and your answer to each question.

NEXT STEP:
TO COMPLETE THIS APPLICATION PROCESS:
    1. PRINT the final copy email which was sent back to you
      (you'll receive it once this form has been completed -
        check your inbox)
    2. SIGN your name where indicated
    3. Have your PARENT / GUARDIAN SIGN where indicated
    4. THE LAST STEP (you have some choices for
         getting your signed final form to us):
         a) BRING IT out to the farm and hand deliver it
         b) MAIL IT TO:
                 JUNIOR LEADER DEVELOPMENT PROGRAM
                  Butterfield Acres Farm
                  254077 Rocky Ridge Road
                  Calgary, AB    T3R 1A6
** APPLICANT INFORMATION **

Tell us about yourself!
NAME NAME First Last
GENDER

GENDER GIRL BOY
BIRTHDATE BIRTHDATE / MM / DD YYYY
WHAT IS YOUR CURRENT AGE?
My HOME ADDRESS is:
City/Town:
Postal Code:
HOME PHONE NO. HOME PHONE NO. - ### - ### ####
ALTERNATE PHONE NO. ALTERNATE PHONE NO. - ### - ### ####
You will be getting a final copy of this application form back right away in your email so you can check it over and then add signatures, before you return it to our office to complete the application process.

In the space below, enter the email address we should use for you.
EMAIL ADDRESS
** WHAT IS USUALLY THE BEST WAY TO CONTACT YOU? **
The BEST way to contact me is, for example
"My home phone number which is 403-555-5555"
or "Email me: Naaaybour@ThePonyFarm.com"
** PARENT / GUARDIAN CONTACT INFORMATION **
** PARENT / GUARDIAN NO. 1 **
PARENT / GUARDIAN #1 - NAME PARENT / GUARDIAN #1 - NAME First Last
PARENT / GUARDIAN #1 - EMAIL
PARENT / GUARDIAN #1CELL PHONE# PARENT / GUARDIAN #1
CELL PHONE# - ### - ### ####
PARENT / GUARDIAN #1ALTERNATE PHONE# PARENT / GUARDIAN #1
ALTERNATE PHONE#
- ### - ### ####
** PARENT / GUARDIAN NO. 2 **
PARENT / GUARDIAN #2 - NAME PARENT / GUARDIAN #2 - NAME First Last
PARENT / GUARDIAN #2 - EMAIL
PARENT / GUARDIAN #2CELL PHONE# PARENT / GUARDIAN #2
CELL PHONE# - ### - ### ####
PARENT / GUARDIAN #2ALTERNATE PHONE# PARENT / GUARDIAN #2
ALTERNATE PHONE#
- ### - ### ####
THE BEST PARENT / GUARDIAN TO CONTACT ABOUT YOUR INVOLVEMENT IN THIS PROGRAM IS...

THE BEST PARENT / GUARDIAN TO CONTACT ABOUT YOUR INVOLVEMENT IN THIS PROGRAM IS... PARENT / GUARDIAN #1 PARENT / GUARDIAN #2
** BEHAVIOUR / HEALTH ISSUES **

Describe any behaviour and / or health issues we should be aware of:
(please include peanut allergies, ADHD, etc)
Details of any behaviour and / or health issues:
If "YES", when did you last attend Day Camp? How old were you?
(select Month / Year / Age from drop down lists.)
* WE LOVE TO SEE APPLICATIONS FROM BOTH CURRENT AND FORMER DAY CAMPERS, ESPECIALLY IF YOU HAVE BEEN REGISTERED IN OUR FARMERS-IN-TRAINING DAY CAMPS !

If you enter "YES" - you've attended Day Camp before, please share the details below.

If "NO" - please continue to the next section, "CAN YOU TELL US...".
Have you ever attended a Butterfield Acres Day Camp?

Have you ever attended a Butterfield Acres Day Camp? YES NO
The MONTH was
The YEAR was...
AGE - I was...
What you remember most about camp?
** CAN YOU TELL US... **
How did you learn about our Junior Leader Development Program? Why would you like to join?
What are 2 (two) things you are really good at?
What are 2 (two) things you'd really like to learn or get better at?
** WORK EXPERIENCE **

What type of "Work Experience" do you have?
This could be any paid or volunteer experience with a business, school or charity. You can also include babysitting or tutoring.
Provide a brief description of your work experience including your duties or responsibilities, your likes or dislikes, and what you feel you gained from the experience?
** INTERESTS / ACTIVITIES / CLUBS / TEAMS **
Do you have any special interests or activites? Do you belong to any clubs or sports teams in your school or community? Dance experience, drama club?, 4H, Pony Club? What do you do for fun?
** AWARDS / RECOGNITION **
Have you received any Awards or Achievements from your school, club or team? If so, what were they for and what did you do to acheive them?
** ADDITIONAL INFORMATION **
Is there anything else you would like to tell us about yourself?
** FARM PROGRAMS & EVENTS **

What programs / events would you like to be involved in? (please check all that apply)
SPRING PROGRAMMING - (check ALL that apply)

SPRING PROGRAMMING - (check ALL that apply) SATURDAYS SUNDAYS HOLIDAYS
Unavailable Dates / Times (please list specific dates and times - if any):
EASTER HUNTS & PETTING ZOOS - (check ALL that apply)

EASTER HUNTS & PETTING ZOOS - (check ALL that apply) some WEEKDAY EVENINGS SATURDAYS SUNDAYS GOOD FRIDAY (specifically) EASTER SUNDAY (specifically)
SUMMER PROGRAMMING - (check ALL that apply)

SUMMER PROGRAMMING - (check ALL that apply) STAMPEDE WEEK PETTING ZOOS SATURDAYS SUNDAYS WEEKDAYS DAY CAMPS (3 week minimum commitment required for all JLDP)
If you checked off DAY CAMPS:
I am available on these weeks this summer:
If you checked off DAY CAMPS:
I am NOT available on these weeks this summer:
FALL PROGRAMMING - (check ALL that apply)

FALL PROGRAMMING - (check ALL that apply) SATURDAYS SUNDAYS HOLIDAYS
Unavailable Dates / Times (please list specific dates and times - if any):
OCTOBER PUMPKIN HUNTS - (check ALL that apply)

OCTOBER PUMPKIN HUNTS - (check ALL that apply) SATURDAYS SUNDAYS HOLIDAYS
Unavailable Dates / Times (please list specific dates and times - if any):
** CHARACTER REFERENCE **
Please provide the name and contact information for two (2) adults whom you have spoken to yourself and who would be willing to be contacted and act as a character reference for you.
REFERENCE #1 - NAME REFERENCE #1 - NAME First Last
REFERENCE #1 - PHONE REFERENCE #1 - PHONE - ### - ### ####
REFERENCE #1 - CELL REFERENCE #1 - CELL - ### - ### ####
REFERENCE #2 - NAME REFERENCE #2 - NAME First Last
REFERENCE #2 - PHONE REFERENCE #2 - PHONE - ### - ### ####
REFERENCE #2 - CELL REFERENCE #2 - CELL - ### - ### ####
PARENT / GUARDIAN APPROVAL, RELEASE FORM &
ACKNOWLEDGEMENT OF RISK

I / We the parent(s) (and/or guardians) of the above child hereby give our approval and acknowledgment to his / her participation in all facets of the JUNIOR LEADER DEVELOPMENT PROGRAM at BUTTERFIELD ACRES FARM, and accept full responsibility and liability thereafter.

I / We do hereby acknowledge and agree that the participation of the child, above named, in this program is at our sole risk and liability; moreover, we hereby release and agree to hold harmless and indemnify BUTTERFIELD ACRES INC., its agents, subcontractors and servants or employees or any responsible adult for any and all actions, the causes of action, claims, liabilities and demand whatsoever arising out of or in any way related to or connected with this program without limitation.

I /We hereby consent to any medical attention or any other care or treatment considered necessary by the staff of BUTTERFIELD ACRES INC. or other responsible adult.
ACCEPTANCE AND UNDERSTANDING OF TERMS

By checking the box below, I agree that...

I have READ, UNDERSTAND and ACCEPT the above stated APPROVAL, RELEASE FORM & ACKNOWLEDGMENT OF RISK .

Approval, Release Form & Acknowledgement of Risk READ, UNDERSTOOD & ACCEPTED?

Approval, Release Form & Acknowledgement of Risk READ, UNDERSTOOD & ACCEPTED? YES

** Signature of Parent(s) / Guardian(s) **
I/We have READ, UNDERSTAND and ACCEPT the above stated APPROVAL, RELEASE FORM & ACKNOWLEDGMENT OF RISK.

____________________________ Date____________

____________________________ Date____________

Signatures required on your final copy of this Application Form which will be in your email box soon after you submit this form. The final copy, signed, needs to be returned to our office.

** Junior Leadership Development Program
APPLICANT CERTIFICATION**
by checking the boxes below, I certify that...

The information contained in this application is complete and accurate to the best of my knowledge.

The information contained in this application is complete and accurate to the best of my knowledge. YES

I completed this Application myself!

I completed this Application myself! YES

** Signature of APPLICANT**

____________________________ Date____________
Required on your final copy of this Application Form which will be in your email box soon after you submit this form. The final copy, signed, needs to be returned to our office.

SECURE ONLINE REGISTRATION

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If you are ever in doubt, look for the lock - - it appears in your web browser window (usually bottom right corner) and/or browser address bar along with the "https://" prefix indicating SSl security is enabled on the current page.

JUNIOR LEADER DEVELOPMENT PROGRAM APPLICATION