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	CIT Application Form - Chabad of Southlake
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window.formJson = Object.extend([{"form_height":808,"10_text":"\u003cp style=\"text-align: justify;\"\u003e\u003cspan style=\"color:#16a085;\"\u003e\u003cspan style=\"font-size: 18px;\"\u003eCIT\u0026#39;s will be working with our campers as well as joining camp on all major trips.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\n\u003cp style=\"text-align: justify;\"\u003e\u003cspan style=\"color:#16a085;\"\u003e\u003cspan style=\"font-size: 18px;\"\u003eThere is a $200 per week fee for the CIT\u0026nbsp;program in order to cover our costs.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\n\u003cp style=\"text-align: justify;\"\u003e\u003cspan style=\"color:#16a085;\"\u003e\u003cspan style=\"font-size: 18px;\"\u003eThere are limited CIT\u0026nbsp;positions available. This form should be filled out by the prospective CIT. Once we receive your application, we will review it and make our determination. If you are accepted your parents will need to fill out the\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003ca href=\"/Article.asp?AID=4321320\"\u003e\u003cspan style=\"color:#16a085;\"\u003e\u003cspan style=\"font-size: 18px;\"\u003eCIT Registration Form\u003c/span\u003e\u003c/span\u003e\u003c/a\u003e\u003cspan style=\"color:#16a085;\"\u003e\u003cspan style=\"font-size: 18px;\"\u003e.\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\n\u003cp style=\"text-align: justify;\"\u003e\u003cspan style=\"color:#16a085;\"\u003e\u003cspan style=\"font-size: 18px;\"\u003eWe will do our best to honor your age request, but can not guarantee it.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\n\u003cp style=\"text-align: justify;\"\u003e\u003cspan style=\"color:#16a085;\"\u003e\u003cspan style=\"font-size: 18px;\"\u003eIf you have any questions please email camp@jewishsouthlake.com or call Rishi (817) 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<form class="userform-form" action="" method="post" name="form_4321207" id="4321207" accept-charset="utf-8"><input type="hidden" name="formID" value="4321207" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_10"><div id="cid_10" class="form-input-wide"> <div id="text_10" class="form-html"><p style="text-align: justify;"><span style="color:#16a085;"><span style="font-size: 18px;">CIT's will be working with our campers as well as joining camp on all major trips.</span></span></p>

<p style="text-align: justify;"><span style="color:#16a085;"><span style="font-size: 18px;">There is a $200 per week fee for the CIT program in order to cover our costs.</span></span></p>

<p style="text-align: justify;"><span style="color:#16a085;"><span style="font-size: 18px;">There are limited CIT positions available. This form should be filled out by the prospective CIT. Once we receive your application, we will review it and make our determination. If you are accepted your parents will need to fill out the  </span></span><a href="/Article.asp?AID=4321320"><span style="color:#16a085;"><span style="font-size: 18px;">CIT Registration Form</span></span></a><span style="color:#16a085;"><span style="font-size: 18px;">.  </span></span></p>

<p style="text-align: justify;"><span style="color:#16a085;"><span style="font-size: 18px;">We will do our best to honor your age request, but can not guarantee it.</span></span></p>

<p style="text-align: justify;"><span style="color:#16a085;"><span style="font-size: 18px;">If you have any questions please email camp@jewishsouthlake.com or call Rishi (817) 933-2877 </span></span></p>
</div> </div></li><li id="cid_24" class="form-input-wide"> <div class="form-header-group"><h3 id="header_24" class="form-header">My Information</h3><div id="subHeader_24" class="form-subHeader">This form should be filled out by the prospective CIT</div></div> </li><li class="form-line" id="id_4"><div class="form-label-top" id="label_4"><label for="input_4"> Full Name<span class="form-required">*</span> </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input-wide"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q4_fullName[first]" id="first_4" autocomplete="given-name" />  <label class="form-sub-label" for="first_4" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q4_fullName[last]" id="last_4" autocomplete="family-name" />  <label class="form-sub-label" for="last_4" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_5"><div class="form-label-top" id="label_5"><label for="input_5"> E-mail<span class="form-required">*</span> </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input-wide"> <input type="email" class=" form-textbox validate[required, Email]" id="input_5" name="q5_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_7"><div class="form-label-top" id="label_7"><label for="input_7"> Cell Number<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input-wide"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q7_phoneNumber[area]" id="input_7_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_7_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q7_phoneNumber[phone]" id="input_7_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_7_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_8"><div class="form-label-top" id="label_8"><label for="input_8"> Grade Entering<span class="form-required">*</span> </label><label class="label-message" for="input_8"> </label></div><div id="cid_8" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_8_0" name="q8_input8" value="8th" /><label id="label_input_8_0" for="input_8_0"><span>8th</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_8_1" name="q8_input8" value="9th" /><label id="label_input_8_1" for="input_8_1"><span>9th</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_8_2" name="q8_input8" value="10th" /><label id="label_input_8_2" for="input_8_2"><span>10th</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_9"><div class="form-label-top" id="label_9"><label for="input_9"> I would like to work with<span class="form-required">*</span> </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input-wide"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_9_0" name="q9_input9" value="Mini Gan" /><label id="label_input_9_0" for="input_9_0"><span>Mini Gan</span></label></span><span class="clearfix"></span><span class="form-radio-item 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References</h3></div> </li><li class="form-line" id="id_17"><div class="form-label-top" id="label_17"><label for="input_17"> Reference Number 1 Name<span class="form-required">*</span> </label><label class="label-message" for="input_17"> </label></div><div id="cid_17" class="form-input-wide"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q17_fullName17[first]" id="first_17" autocomplete="given-name" />  <label class="form-sub-label" for="first_17" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q17_fullName17[last]" id="last_17" autocomplete="family-name" />  <label class="form-sub-label" for="last_17" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_18"><div class="form-label-top" id="label_18"><label for="input_18"> Reference Number 1 Phone Number<span 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Name</label></span> </div></li><li class="form-line" id="id_22"><div class="form-label-top" id="label_22"><label for="input_22"> Reference Number 2 Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_22"> </label></div><div id="cid_22" class="form-input-wide"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q22_phoneNumber22[area]" id="input_22_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_22_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q22_phoneNumber22[phone]" id="input_22_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_22_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_23"><div 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