2015 CYLC
DFW Community Youth Leadership Camp
青少年領導才能營
Theme: Confidence
主題：信心
主辦單位
中華青少年義工團
協辦單位
美華協會達福分會
中國工程師學會
Community Youth Leadership Club (CYLC)
Organization of Chinese American (OCA-DFW)
Chinese Institute of Engineer(CIE/USA-DFW)
TAMU / Commerce, Texas
7/20 - 7/25
2015 CYLC Youth Leadership Camp
CYLC Mission Statement
To provide direction, leadership and guidance while building confidence through enhancing
communication and team building skills in aspiring Chinese American youth. To prepare young Chinese
American leaders for the mainstream community and reinforce their pride in being Chinese American.
CYLC Camp Objective
To provide the youth a safe environment to build friendships, cooperation techniques, and social skills.
Through group activities, campers should learn self discipline and communication skills to empower them
to take responsibility for their behavior. To encourage campers to creatively express themselves, to learn
accountability, trust, and how to solve conflicts and collaborate with peers.
To strengthen their
confidence in goal setting and decision making through camp activities and team-building exercises.
CYLC dates: July 20th (Monday) to July 25th (Saturday), 2015
CYLC location: TAMU – Commerce, Texas.
Activities: Leadership Training – Self awareness, personal characteristic analysis, team
building, brainstorming, project designing, presentation skills, communication models,
result evaluation, a thorough series of leadership courses and activities.
Group Activities – Leadership workshop, team games, filming, etiquette, physical
activities, dance, music, arts and crafts, swimming, and talent show
Cultural Programs – Chinese arts and crafts, dance, and culture classes
Registration:
We take 400 campers on first-come first-accept basis.
1. On line registration by assigned age group day and receives application confirmation number
2. Camp administrator will send email for acceptance announcement.
3. Fill out the application form and waiver form.
4. Attach a copy of your medical insurance card front and back and prove of birthday.
5. Include a check for $485 camp fee. Make checks payable to CYLC.
Mail in forms/check after acceptance confirmation:
CYLC, PO Box 868156, Plano, TX 75086 (Post Mark before 1/31/2015)
Notice:
Any incomplete registration form will not be accepted. CYLC will not take responsibility for a
delayed registration which results in a disqualified application. Please enter the correct
information and complete the application.
Please check carefully before submitting registration.
1. Application Form (Include counselor application if you wish to apply, essay/resume
can be submitted before 3/20)
2. Health Insurance Copy (copy of insurance card front and back)
3. Online Application Confirmation Page
4. Signed Medical Release Form & Activity Permission Slip
5. Camp Rules Form: Please carefully read the Camp Rules. Parent and camper must agree
and both must sign the camp rules and return it with the application form.
6. Camp fee $485.00 Check pay to CYLC by money order or personal check.
A
Bounced Check will disqualify the camper and the registration will be returned. You will be
responsible for all returned checks fees for our bank and yours. Write the Camper’s name on the
check.
7. TAMU Waiver Form
8. Counselor application form
has to submit with Camp acceptance package after the on
line application acceptance if want to apply for counselor. Counselor required resume, essay, and
code of conduct are due on 3/20 (Post Mark) for qualification of interview schedule. Counselor
interview: 3/28 Saturday 8:00AM – 6:00PM
No walk-ins on 3/28 counselor interview day. Individual interview time will be notified by e-mail.
8. CYLC will random check birth certificate/passport to verify the birthday.
9. CYLC will send out a letter for directions, camper luggage requirements, and preparation
instructions one week before the camp starts in July.
10. CYLC provides transportation on 7/20 8:00AM from Plano to camp, but parents are responsible
for picking up the camper on 7/25 at TAMU after final performance.
Website: www.cylc-dfw.com Facebook: CYLC
Contact Email: cylc1shannonchen@gmail.com
CYLC, PO Box 868156, Plano, TX 75086
2015 CYLC Youth Leadership Camp
For Office Use Only
Camp date：7/20 - 7/25 six days five nights
Camp location： TAMU - Commerce, Texas
Age： At least 9 years old (by 8/31/15)
Class
Student #
Room #
2015 CYLC Registration Form
CHINESE NAME:
AGE:
ENGLISH NAME:
BIRTHDAY:
3
CURRENT GRADE:
4
5
6
7
GENDER:
8
9
10
11
12
The current grade for Spring semester of 2015
ADDRESS:
(include apt. #, city, state & zip Code)
PARENT(S) NAME:
Father:
Mother:
TEL (Home):
Father (Cell):
Mother (Cell):
E-mail:
UNIFORM SIZE:
Child
L
M
Adult
XL
L
M
S
EMERGENCY CONTACT：NAME:
TEL:
RELATIONSHIP:
ROOM MATE: (Please remind the roommate to submit the application at the same time)
CHINESE NAME:
ENGLISH NAME:
STUDENT
E-MAIL ADDRESS:
HEALTH INFORMATION
MEDICAL INSURANCE
INSURANCE CO：
INSURANCE #：
ALLERGY
MEDICINE：
FOOD：
HEALTH
GOOD
Special Care:
ADD with medication
Others：Make Checks payable to: CYLC. Each applicant has one check with name on check
Refund in special cases must be submitted with written request.
1. $50 registration fee is non-refundable
2. Refund with $50 deduction before 4/1/15
3. Half refund with $50 deduction before 5/1/15. No refund after 5/1/15.
For Office Use Only
Camp fee $485.00
Check #
(Includes $50 non-refundable registration fee)
Received Date:
Notice：Please fill in all blanks. Incomplete forms will not be accepted. CYLC reserves the right to
deny applications for providing false information and expel campers who have behavior problems
or violate CYLC camp rules. Please make sure the roommate also submits the application form at
the same time.
2015 CYLC Youth Leadership Camp
Medical Release Form
This is to certify that I grant permission for my dependent child,
, (Date of
birth at _____________) to receive medical treatment by University physicians, while attending
CYLC summer camp at the TAMU-Commerce, Texas. I further authorize treatment at local
hospitals by physicians at those facilities, should such treatment be required. I understand that I
will be responsible for any and all medical charges or fees.
SIGNED:
DATE:
PHONE: Father (M)
Mother (M)
Email: Father ___________________
Mother ______________________________
My medical insurance company is
Medical Provider Phone:
My policy number is:
(Please attach a copy of the medical insurance card)
Activity Permission slip
My child
has my permission to take the transportation provided by 2015
CYLC summer camp from Asia World to TAMU, Commerce Texas.
My child
has my permission to participate in all water activities in the
2015 CYLC summer camp at TAMU, Commerce Texas.
I give my permission to 2015 CYLC to make or use pictures, slides, digital images, or other reproductions
of my child ___________________________.
The undersigned as legal guardian of the student do hereby grant to the staff of the CYLC summer
camp in my absence, the authority to render judgment concerning medical assistance in the event of an
accident. I do not hold the CYLC summer camp, its teachers, staff, or school responsible for any and all
injuries occurred during the activities provided by the CYLC summer camp, and I so signify by signature
below:
SIGNED:
DATE:
_____________
2015 CYLC Camp Rules
General Rules:
 The camp director reserves the right to reprimand any violators.
 Follow TAMU Campus policies. Follow instructions given by camp staff.
 Be prompt and present at all scheduled camp activities.
 Stay within the campsite or assigned places. Absolutely no one leaves from the camp
without the written consent of the camp staff.
 Wear the camp provided T-shirt at all times. No alterations of or markings on T-shirts
are allowed. The dress code is the same as PISD regulation.
 Smoking, consumption of alcoholic beverages, and drug use are strictly prohibited.
 Absolutely no gambling, fighting, or carrying of dangerous objects (such as fireworks,
firearms, knives, match, etc.) is allowed.
 In case of an emergency you must report to the staff immediately.
 All trash must to be disposed of properly.
 No gum chewing is allowed at this camp. No handheld games allowed.
Dormitory Rules:
 Keep room and facilities clean and tidy. Adult camp staff will conduct daily inspections.
A warning will be issued for violations.
 Curfew is strictly observed, and adult staff will conduct room checks after 10 PM.
 No visitations by campers of the opposite sex are permitted.
 Absolutely no room switching.
 Be considerate. Do not create noise. No phone calls after 10:00 PM.
Classroom Building Rules:
 Maintain order. Follow teacher instructions and show good manners.
 Do not create noise in the hallways.
 Keep classrooms clean. No cell phone usage during class time.
Dining Hall Rules:
 Stay in line to receive food. Be courteous and helpful to younger campers.
 Only take what you can eat and eat what you take.
 Keep the dining hall absolutely clean.
Check Out Rules:
 Parents will be responsible for picking up their camper who becomes ill, or is injured, or
has problems adjusting to group life, or violates camp rules and is dismissed by the
camp authorities.
 Except for the above conditions, no early dismissal is allowed. All campers are required
to attend the closing ceremony.
 Parents will be liable for any facility or property damages caused by their child.
By signing below, I the camper, and my parents, agree to the rules above. I agree to
obey them fully.
Camper’s Signature
Date
Parent or Guardian’s Name Parent or Guardian’s Signature
(Please print name)
Date
2015 CYLC Counselor/Assistant Counselor
Application Information
1. Scholarship: Amount to be decided by the Committee.
2. Requirements:
1) Teacher Assistant - College student.
2) Counselor - At least sixteen years old by Aug. 31, 2015
3) Assistant Counselor - At least fifteen years old by Aug. 31, 2015
4) Accepted by the CYLC Committee after interview and evaluation.
5) Head counselor - Has prior camp serving experience or has received formal leadership
training.
6) Must attend CYLC Junior Leadership Seminar on May 16 and CYLC Leadership
Training on June 20, 21, June 27, 28, July 11, 12 (excused absent such as family
vacation, other activity and medical/dental rest no more than 2 days by prior notification).
CYLC expects full participation of all physical activities during training sessions.
7) Perform duties according to the following job description during camp 7/20-7/25.
8) The Disciplinary Committee Director reserves the right to award scholarships to
Counselors and Assistant Counselors
3. Job Description:
1) Teacher Assistant (TA) - Teaching
 Assist teachers and act as substitute teacher when necessary.
 Support C/AC for team activities.
 Consult with Camp Director and Camp Consultants.
2) Head Counselor (HC) - Lead Camp counselor activities
 Supervise Counselors and Assistant Counselors
 Consult with Camp Director and Camp Consultants.
3) Counselor - Report to HC/Camp Director/Teachers for duties and assignments.
 Assist campers’ arrival, move-in and departure.
 Observe campers’ daily activities and conducts. Report any irregular behavior to the
Head Counselor and teachers immediately.
 Direct campers to scheduled classes and activities punctually, being vigilant of
campers’ safety, discipline and attendance.
 Lead campers’ group activities and coordinate Assistant Counselors’ job
assignments.
 Attend nightly review meeting.
4) Assistant Counselor (AC) - Report to Counselors for duties and assignments.
 Attend classes on time like all other campers.
 Collect and distribute camp uniforms every night.
 Assist campers to follow scheduled activities such as dining, studying, taking recess
and other activities in a timely manner.
 Keep dorm, classrooms, and dining hall tidy and orderly.
TAs, Counselors and ACs must follow all policies, regulations, and the training schedule of
CYLC leadership camp. You are also required to demonstrate a high standard of self-discipline
in your personal conduct and all social interactions. Any misconduct will result in immediate
termination of duties and/or scholarship, or possible dismissal from camp. Signed Code of
Conduct Agreement by parents and C/AC are required if selected.
2015 CYLC Youth Leadership Camp
Counselor/Assistant Counselor
Application Form
Name (Chinese)
2x2
Headshot
Photo
Date of Birth
Name (English)
Address:
Sex:
Applicant Cell:
*Most recent camp experience:
M
F
Age:
E-Mail:
Grade:
Fax:
Year
*If you are chosen to be a Counselor/Assistant Counselor, which group would you like to work
with? Circle or Check one:
9-10
10-11
12-13
14-15
1. Why do you want to be a Counselor/AC at CYLC summer camp?
2. Please list your special talents:
3. Describe your skill levels for movie editing and photo shooting:
Please note: Attending CYLC summer camp training is required for Counselors/Assistant
Counselors on June 20, 21, June 27, 28, July 11, 12 (Excused absence no more than 2 days)
Signed agreement by parents and C/AC are required if selected. Unexcused absences
from training will result in dismissal from the position.
Interview Information:
Date: March 28, 2015 Saturday 8:00AM - 6:00PM (Scheduled interview time will be notified)
Place: Will be notified with interview schedule
‧
Registration form (both camp & C/AC application forms), resume, and proposal must
be received by 3/20. Otherwise, your application will be disqualified.
Proposal: Why is “Confidence” meaningful to CYLC and how can you apply it to
your leadership?
‧ For questions, please contact
E-mail: cylc1shannonchen@gmail.com
________________________________________________________________________
For Committee Use Only
‧
Class
Comment:
Counselor
Assistant Counselor
2015 CYLC Youth Leadership Camp
Counselor / Assistant Counselor Code of Conduct Agreement
I,
, as a CYLC selected counselor / assistant counselor, will
follow all CYLC policies, camp rules, and codes of conduct during CYLC training and the camp
period from May to July 2015.
I will:
1. Demonstrate a high standard of self-discipline in personal conduct and social
interactions.
2. Ensure to attend the counselor training as agreed schedule below.
3. Attend team meetings and complete team assignments.
4. Make up works for absence days.
5. Observe and follow all environmental, health, and traffic safety rules.
I will attend C/AC training on the days I checked below. I am aware that only two excused days
of absence are allowed.
5/16, JLS*
6/20
6/21
6/27
6/28
7/11
7/12
*5/16 Junior Leadership Seminar (C/AC meet and greet session, please reserve the whole day)
Please list all other camps or activities you will attend during June-July period other than CYLC.
Activity Name
Date
I understand that any misconduct or unexcused absence of C/AC training or scheduled team
meetings will result in immediate termination of duties, scholarship, and possible dismissal of
camp without dispute. No camp fees are refunded after 5/1/2015.
C/AC Name: __________________________ Parent’s Name: ______________________
(Print)
(Print)
Signature:
Date:
_________________________
___________________________
Signature:
Date:
________________________
________________________