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Summer Internship Application

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Parent's Name
Parent's Name
Please check all activities you are prepared to supervise or teach:
Which best describes your swimming ability?
Are you currently certified in any of the following?

Please check all that apply to you below and provide details for items checked.

Dietary Restrictions?
Medical/Psychiatric Problems?
Physical Disabilities?
Medications Required?
Special Needs?

Emergency Contact Information

First Contact
Second Contact
Insured's Name


While serving as an intern/staff assistant in the The Inn's Summer Internship, I agree to adhere to the highest moral standards in conduct and dress and to submit to the oversight of The Inn staff. I agree there should be NO use of alcohol, tobacco or illegal drugs. As the variety of classes, activities, and chores present themselves, I am willing to do any tasks assigned.

I understand that in addition to assigned duties, an integral part of the Internship/Assistantship will be specialized Heroes of Today training activities in which I will participate.


Please list three references (NOT including family members or peers) whom you feel know you well.
Reference #1
Reference #2
Reference #3