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CIT Application
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• Our Pillars • Engman Camp Shalom •
CIT Application

Thank you for your interest in being a madrich at Engman Camp Shalom this summer. Please fill out the form below.

Step 1 of 3

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Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Mobile Phone*
Email*
Date of Birth*
MM
DD
YYYY
Grade For Incoming School Year*
T-shirt Size*
Emergency Contact Name*
First Last
Emergency Contact Phone Number*
Do you have any allergies or medical conditions?*
- No
- Yes
Please explain
Which weeks are you available to work at Engman Camp Shalom?*
- Week 1 (June 8-12)
- Week 2 (June 15-19)
- Week 3 (June 22-26)
- Week 4 (June 29-July 3)
- Week 5 (July 6-10)
- Week 6 (July 13-17)
- Week 7 (July 20-24)
- Week 8 (July 27-31)
- Week 9 (August 3-7)
- Week 10 (August 10-14)
- Week 11 (August 17-21)
Week 1 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 1 Cost
Price: $25.00
Week 2 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 2 Cost
Price: $25.00
Week 3 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 3 Cost
Price: $25.00
Week 4 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 4 Cost
Price: $25.00
Week 5 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 5 Cost
Price: $25.00
Week 6 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 6 Cost
Price: $25.00
Week 7 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 7 Cost
Price: $25.00
Week 8 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 8 Cost
Price: $25.00
Week 9 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 9 Cost
Price: $25.00
Week 10 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 10 Cost
Price: $25.00
Week 11 Needs
- Hot Lunch
- Morning Transportation
- Afternoon Transportation
Week 11 Cost
Price: $25.00

Why do you want to work at Engman Camp Shalom?*
List three qualities you feel would make you a successful CIT*
What type of extracurriculars are you involved in?*
What age group do you feel most comfortable working with and why?*
Please list anything else you feel we should know about you

Registration Cost
$0.00
How would you like to pay?
- In Person
- Mail-In Check
- Credit Card
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Comments
This field is for validation purposes and should be left unchanged.

Our Pillars

Gan Shalom Preschool
Beit Sefer Shalom
Engman Camp Shalom
Jewish Community Relations Commission
Iowa Jewish Historical Society
Jewish Family Services
Iowa Holocaust Memorial
Partnership2Gether

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Jewish Federation of Greater Des Moines

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Phone: 515-987-0899
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Charity ID Number: 42-0835321

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