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		Junior Leader Development Program Application Form Instructions: Complete this application, then print off this form, sign, and mail, or deliver, it to: Junior Leader Development Program Butterfield Acres 254077 Rocky Ridge Road Calgary, T3R 1A6 Tell us about yourself! Your First Name: Last Name: Gender: Birthday: Month Day Year Current age: Snailmail Address: City: Postal Code: Phone: Home. Cell: Your E-mail address: Best way(s) to contact you?? Parent #1: Name: Cell Work Home : Parent #1 E-mail address: Parent #2: Name: Cell Work Home : Parent # 2 E-mail address: Best parent to contact about your involvement in this program: When/what involvement appeals to you? (Please "check" all the appropriate boxes) Spring: Saturdays Sundays Holidays unavailable days/times, if any : Easter Hunts & Petting Zoos : some weekday evenings Saturdays Sundays Good Friday, specifically Easter Sunday, specifically unavailable days/times, if any : Summer : Stampede week Petting zoos Saturdays Sundays weekdays Day Camps unavailable days/times, if any : Fall: Saturdays Sundays Holidays unavailable days/times, if any : October Pumpkin Hunts : Saturdays Sundays Holidays unavailable days/times, if any : Do you have any behaviour and/or health issues we should be aware of: (please include peanut allergies, ADHD, etc) Names and phone numbers of 2 character references whom we may call: Reference #1 Name Cell # Home # Business # Reference #2 Name Cell # Home # Business # Why you would like the join the Junior Leader Development Program? Tell us about any previous 'work' type experiences (paid or volunteer) you've had. Do you have any special hobbies, sports or interests? Are you on any teams, ever entered the Science Fair, etc Have you received any special awards or achievements at school? If so, what were they for, how did you earn them, when did you receive them, etc. 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 acknowledgement 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. I have read, understand and ACCEPT the terms listed above Parent #1 Signature ________________________________________ Date___________________ Parent #1 Name printed: Parent #2 Signature ________________________________________ Date___________________ Parent #2 Name printed: PLEASE PRINT OFF THIS FORM, PARENTS SIGN ABOVE, THEN MAIL, or bring it to Butterfield Acres 254077 Rocky Ridge Road Calgary, T3R 1A6 Attention: Junior Leader Development Program The next step: The big interview! As positions in the program become available, we call selected candidates in for an interview. Applications are kept on file for 1 year. Most of our new openings occur during spring and summer each year. Thank you for your application! or if you need to start over you may

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