2022 4 -H Summer Camp Counselor Application

4-H Camp Counselor Application 2022

Due to your County Extension Office by Tuesday, February 15, 2022.
Camp dates for both Youth Camp (grades 3-5) & Teen Camp (grades 6-8) is June 21-23, 2022:
Counselors must plan to arrive at camp on June 20th.

Campers will arrive on June 21st and will be there until June 23rd.

You must have completed 9th grade by summer 2022 to be a counselor for Youth Camp, and completed 10th grade by summer 2022 to be a counselor for Teen Camp.

A paper application is also available online, if that is what you prefer.
*

New Counselor Returning Counselor
Number of years you have been a counselor *
Full Name *

First Name Last Name
Address *

Street Address

City State / Province

Postal / Zip Code
What county do you live in? *
What county do you live in? *

Freeborn Rice Steele Waseca Other
Your cell phone number *
Your e-mail *
example@example.com
Age as of June 20, 2022? *
Grade Completed: *
T-shirt size: *
Please choose the camp session you are applying to be a counselor: *
Parent Information: *

Name(s)

Name

Cell Phone

Email Address

References
Please list names, email address and both home and cell phone numbers of two personal references other than family members or Extension Staff. (For example: teachers, clergy, youth group leaders, employers, etc.)
Reference #1: *

Name

Name

Relationship Cell Phone

Email Address
Reference #2: *

Name

Name

Relationship Cell Phone

Email Address

Training and Certification

If you are chosen to be a camp counselor you will have trainings that you are required to attend. In order to be a counselor, you MUST be able to attend the first training. As a group, we will determine the remaining training dates based on schedules and the needs for camp.
I can attend the day long training on Saturday, April 30, 2022. (Location & exact times are to be determined) *

yes no
Are you certified in First Aid? *

yes no
Date of Certification: *

Month Day Year
Date
Submit a copy/photo of your certification: *

Cancel of
Are you a certified Life Guard? *

yes no
Life Guard Certification Level: *
Submit a copy/photo of your certification: *

Cancel of

Application Questions
Describe any previous experience you have as a counselor, working at camps, etc… *
Have you attended a camp before? If so, please describe the camp and your experience (what you learned, what you enjoyed most, etc.). *
What are your greatest strengths that you would use as a counselor? *
Please describe other youth leadership experiences you have had in your club or county, within 4-H or outside of 4-H. *
What makes you the best applicant to be selected as a camp counselor? *
What contributions do you feel you can make to camp? *
What do you feel will you improve upon if you are selected as a counselor? *

Youth Commitment:
As a camp counselor, I commit myself to:
- Attend camp counselor trainings
- Attend additional counselor trainings as scheduled
- Abide by the expectations laid out in the Code of Conduct found on the MN 4-H website
- Set a good example by not using profanity, negative language, or telling off-color jokes or stories
- Never punish a camper by ridicule or physical punishment - patience and understanding works wonders in youth development
- Create an atmosphere of fun and friendship and keep a cheerful and positive attitude
- Get to know the members of my camper group the best I can and help them to get acquainted with one another and the other counselors
- Treat all campers fairly and with respect and see that all campers become involved and 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, and activities.
- Help maintain the location and room environment (pre and post camp clean up)
- Ask adults for advice and help if I cannot handle a camp situation
- Remain in cabin with campers 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
- Use appropriate boundaries between campers, staff, and other counselors
  Absolutely no physical relations among counselors and/or staff. Further, opposite sex campers and counselors are not permitted in each other’s cabins at any time
- Be an active member of a counselor team that supports, encourages, and respects the thoughts, ideas, and work styles of other team members
By signing 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 items listed above.
Youth Signature: *

Clear
Parent/Guardian Signature: I agree that my child can attend camp counselor trainings and serve as a camp counselor according to the stated commitments. *

Clear
Should be Empty:

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4-H Camp Counselor Application 2022

References

Training and Certification

Application Questions

Youth Commitment: