4-H Camp Counselor Application - 2018                                                                                                                                                                              
Being a counselor for 4-H camp is a great way to develop leadership skills, learn more about your strengths, make new friends, learn new skills, and have a lot of fun.  You will have the responsibilities of supervising youth, facilitating camp activities, and creating a fun and supportive environment for youth!  

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Email *
First Name:   *
Last Name:   *
Please select one *
If you are a returning counselor, how many years have you been a counselor?  Please also indicate when & where.
Mailing Address: *
(house number & street name or PO box)
City *
State *
Zip Code *
County *
Current Grade *
Current Age *
Your Cell Phone Number *
Parent/Guardian Name(s) *
Last, First
Parent Cell & Home Phone Number(s) *
Parent Email(s) *
T- Shirt Size *
Please choose which camp(s) you are applying for: *
Youth Camp is held at Camp Patterson and you must have completed 9th grade to be eligible.  Teen Camp is held at Camp Omega and you must have completed 10th grade to be eligible.
Required
Initial Camp Counselor Training Date *
If you are selected to be a camp counselor, there are 2-3 trainings that you are required to attend.  If you are chosen to be a counselor for both youth and teen camp, then you will need to attend separate trainings for each.  We prefer that you attend the training of the camp where you will be counseling; if it does not work in your schedule choose the other training date.
Did you attend 4-H camp as a youth? *
If you did attend 4-H camp, please describe your experience (what you learned, what impacted you most, etc.)
Why do you want to be a Camp Counselor? *
Describe other youth leadership experiences you have had as a 4-H member at the club and/or county level as well as outside of 4-H. *
What do you think are your greatest strengths that will help you as a camp counselor? *
What do you think are the weaknesses that you need to work on to be a camp counselor? *
Why should we choose you to be a camp counselor? *
Are you certified in First Aid? *
If you are certified in First Aid, please list the date of certification.  You'll be required to provide a copy of your certification prior to camp.
Do you have your Life Guard Certification? *
If you are a life guard, please list the date of certification.  You'll be required to provide a copy of your certification prior to camp.
Do you play a musical instrument? *
If you play a musical instrument please list.
Do you have any other special talents or ideas you think would benefit camp?
Name of Reference #1 - Cannot be related or Extension Staff *
Last, First
Your relationship to reference #1 *
Home Phone and Cell Phone Number *
Email Address *
Name of Reference #2 - Cannot be related or Extension Staff *
Last, First
Your relationship to reference #2 *
Home Phone and Cell Phone Number *
Email Address *
 Youth Commitment - As a Camp Counselor I commit to the following: *
As a camp counselor, I promise to:  *attend initial camp counselor training, *attend additional counselor trainings as scheduled, *not have in my possession or use tobacco, alcohol, or illegal drugs while I am participating in the counselor program or at 4-H camp, *set a good example by not using profanity or telling jokes or stories that are racist or discriminatory in any way, *never punish a camper by ridicule or physical punishment, *create an atmosphere of fun & friendship and keep a cheerful & positive attitude, *get to know the members of my camper group the best I can and help them get acquainted with one another & the other counselors, *treat all campers fairly & with respect and see that all campers become involved & have a part in each activity, *give up my personal interests so the needs of the campers can be met, *willingly assist those in charge of the camp and be prompt for all meetings, meals & activities, *help maintain the location and room environment (pre & post camp), *ask adults for advice and help if I cannot handle a camp situation, *remain in my cabin after lights out, *remain with/be aware of campers at all times other than designated counselor breaks, *actively participate in all aspects of the camp with a positive attitude, *maintain appropriate boundaries between campers, staff, & other counselors, *have absolutely no physical relations with other counselors and/or staff; I understand that campers & counselors of the opposite sex are not permitted in each other's cabins at any time, *be an active member of a counselor team that supports, encourages & respects the thoughts, ideas & work styles of other team members.  Additionally, if given my cell phone during camp I will not be on it in the cabin or any time during camp other than using it for pictures and emergency situations.  
Youth Commitment:  By entering my name & date below, I acknowledge that I have read and agree to abide by the above responsibilities if selected as a camp counselor.  I understand and agree that I will be asked to call my parents/guardians immediately to pick me up if I do not conduct myself in an appropriate manner, which includes being out of my cabin after hours and/or the possession of tobacco, alcohol or illegal drugs. *
Please type in your name and date.
Parent/Guardian Commitment: By entering my name & date below, I agree that my child can attend camp counselor trainings and serve as a camp counselor on the dates listed and according to the stated commitments.   *
Please type in parent/guardian name and date.
A copy of your responses will be emailed to the address you provided.
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