Village Youth Delegate Application supplement Village Youth Delegate Application Supplement Step 1 of 6 16% Village Delegate Application SupplementYour Name(Required) First Last My Family and HomeBrothersPlease enter a number from 0 to 10.SistersPlease enter a number from 0 to 10.We PlayWe Play Do you like or dislike playing aloneDo you like or dislike playing alone Like Do not like How do you help out at home?The thing i like most about my home is...The thing i like most about my home is...My favorite food is...My favorite food is...My least favorite food is...My least favorite food is...Do you like to try eating new things?Do you like to try eating new things? Yes No My FriendsMy best friend is...My best friend is...I like them because...I like them because...Who's house do you prefer to play at?Who's house do you prefer to play at? My house My friends house Why do you prefer to play there?Why do you prefer to play there? My PetsWhat pets do you have?What pets do you have?Do you help take care of your pets?Do you help take care of your pets? Yes No If you don't have pets, is there a reason?If you don't have pets, is there a reason?My Travels and AdventuresWhat different ways have you traveled Bus Car Aitplane Boat Train Bicycle Pony What kind of places have you been to? Circus Zoo Farm Hotel Airport Fire Station Factory Museumn The best adventure I ever had was...The best adventure I ever had was...I like to read aboutI like to read aboutThe best book I ever read wasThe best book I ever read wasHow many books of your own do you have at home?How many books of your own do you have at home?Do you ever borrow books from the library?Do you ever borrow books from the library? Yes No Movie and TV FavoritesHow many movies do you watch a month?How many movies do you watch a month?How many TV shows do you watch a day?How many TV shows do you watch a day?what is your favorite TV show or movie?what is your favorite TV show or movie?What kind of music do you like to listen to?What kind of music do you like to listen to?Likes and DislikesWhat kind of things do you like?What kid of things do you not like?What are you afraid of?What are you afraid of?What do you like best about school?What do you like best about school?What are you not afraid of?What are you not afraid of?What do you do when you have nothing else to do?What do you do when you have nothing else to do? My WishesWhen I grow up I want to be...When I grow up I want to be...If I could have 3 wishes they would beWish 1Wish 1Wish 2Wish 2Wish 3Wish 3Please answer the following questionsHave you atended a camp before? Yes No Which Camp?Which Camp?What did you like/ dislike about camp?What did you like/ dislike about camp?Describe any other experiences away from home without your parents.Describe any other experiences away from home without your parents.Describe a recent happy day in your life.Describe a recent happy day in your life.How do you imagine you will feel being away from your family and home for 1 month?How do you imagine you will feel being away from your family and home for 1 month? Village Family Responsibilities• Host meetings in the home in preparation for the Village experience and as a follow-up after the delegation returns. • See that the delegate attends scheduled delegation meetings. • Attend parent meetings and participate in Chapter activities. • Pay all fees designated by the Chapter by the established deadlines. • Complete the delegate’s passport and visa application, if applicable, within two weeks of selection notification. • Submit the required CISV Health and Legal Information forms by the established deadlines and obtain any necessary immunizations. • Decide with the leader and other parents the amount of spending money to take to the Village and comply with that decision. • Provide emergency money as determined by the delegation leader and Chapter with the understanding that emergency money not used will be returned to parents. • Cooperate fully with the delegation leader and encourage your child to accept the leader’s authority during the preparation and travel phases and at the Village. • Be informed about the CISV program so that you can provide a positive and supportive atmosphere for your child. • Help your child understand that he/she is representing the Chapter and the United States as a goodwill ambassador. If a child’s behavior is unacceptable at a Village it is the parent’s responsibility to make arrangements to bring the child home. According to National CISV policy, children under 16 may not travel unless accompanied by an adult. • Assist your child in sharing the Village experience at a Chapter meeting and at other non-CISV meetings for publicity purposes if asked. • Participate in evaluations of the Village experience as requested by the Chapter. • Support and participate in Chapter activities throughout the year and keep informed of Junior Branch activities so that the delegate can participate. I have read and understand the National Travel PolicyFamily AcknowledgementWe are aware of CISV’s policy for selection, preparation, training and the responsibilities of Village delegates and their families. We are prepared to let our child participate in a CISV Village Program and regard him/her/them as both physically and psychologically fit to participate. We are also prepared to support our child in his/her/their future involvement in CISV. Applicant Signature(Required)Parent/Guradian 1 Signature(Required)Parent/Guradian 2 Signature(Required)Upload a photo of your delegateMax. file size: 20 MB.
