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Junior Leader Development
Program Application Form

Instructions for the Applicant:

1) Print print off this this application.

2) The APPLICANT fills the Application - in their own words and handwriting (this is really important, parents!!! hint, hint!).

3) Add parent signatures.

4) FAX it to us at 403-241-5078,

or scan & email to farmfun@ButterfieldAcres.com,

or mail/deliver it to us at:

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 :
Cell Work Home :

Parent # 2 E-mail address:

Best parent to contact about your involvement in this program:

Describe any behaviour and/or health issues
we should be aware of: (please include peanut allergies, ADHD, etc)

Have you ever attended a Butterfield Acres Day Camp? Tell us when, your age then, and what you remember about camp.

Names and phone numbers of 2 adults whom you have spoken to yourself and who would be willing to act as a character reference for you:

Reference #1 Name

Cell # Work Home :

How do you know this person?

Reference #2 Name
#ell # Work Home :

How do you know this person?

Why you would like the join the Junior Leader Development Program?

Tell us 2 things you are really good at, then 2 things you'd really like to learn or get better at.

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, have you 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.

Is there anything else you would like to tell us about yourself?

What would you like to be involved in?

(Please "check" all boxes that apply to you.

Spring Programming:
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 Programming:
Stampede week Petting zoos
Saturdays
Sundays
weekdays
Day Camps
unavailable days/times, if any :

Fall Programming:
Saturdays
Sundays
Holidays
unavailable days/times, if any :

October Pumpkin Hunts :
Saturdays
Sundays
Holidays
unavailable days/times, if any :

Applicant's signature :

Parent/Guardian Approval, Release Form, Acknowledgement of Risk

I have read, understand and ACCEPT the terms in the box above

Parent #1 Signature ________________________________________

Date___________________

Parent #1 Name printed:

Parent #2 Signature ________________________________________

Date___________________

Parent #2 Name printed:

PLEASE PRINT OFF THIS FORM, APPLICANT COMPLETES IT IN THEIR OWN WORDS AND HANDWRITING; THEN PARENTS SIGN ABOVE,
and FAX to 403-241-5078
or scan and email to farmfun@ButterfieldAcres,com

or MAIL/ bring it to

Butterfield Acres
254077 Rocky Ridge Road
Calgary, T3R 1A6
Attention: Junior Leader Development Program

The next step: The big interview! When positions in the program become available, we call selected candidates for an interview. Applications are kept on file for 1 year. Most of our new openings occur during spring and summer each year, with our largest interview period starting February each year.

Thank you for your application!

Proud to be associated with the AMA Tour Book, Child Friendly Calgary, Tourism Calgary.