Application for Clatsop County 4-H Camp Counselor
1. Applicant must be currently enrolled in a 4-H project.
Lock-In Training is
MANDATORY
April 29/30
6:30pm
2. Applicant must be currently enrolled in 8-12 grades
3. Application will consist of
a. A completed application form
b.
One letter of recommendation (not from parent). You can use the Recommendation Sheet
attached, or a letter can be written—REQUIRED.
c.
Counselors chosen must agree to attend training and planning sessions prior to camp
d.
Parental consent is required
e.
A short interview will be conducted at the Camp Counselor Lock-In.
f. Camp counselors will be chosen to serve based upon the needs of the camp, application process,
experience, the number of campers enrolled, and grade enrolled in (we want a few youth from all
grades 8-12)
g. Those youth chosen as camp counselors must be available to attend camp in its entirety.
h. Counselors 16+ are required by the state 4-H office to fill out a background check-every 2 years
i. Please be aware everyone applying may not be selected. Applicants will be selected by June 1
COMPLETED APPLICATION DUE BY THE TRAINING
ON APRIL 29, Warrenton Elementary School Cafeteria
If you understand and accept the conditions of Camp Counselorship, then please sign and return your
application to the Extension office prior to April 29 or bring to the training.
Your Signature ________________________________
Date: _____________________
PARENTS PLEASE NOTE:
Please indicate that you have reviewed this application, that you understand what your teen would be
assuming, and that you support this commitment.
_____________________________________________
(Parent or Guardian Signature)
Summer Camp, 2016
______________________
(Date)
CLATSOP COUNTY CAMP COUNSELOR APPLICATION
Name ________________________________________________________ Phone __________________
Mailing address __________________________________City ________________Zip _______________
T-Shirt Size ________________ Grade __________ Age ___________ Male _______ Female ______
e-mail address _________________________________________________________________________
Have you ever been a counselor before? ___________ If "YES", when? (please explain)
_____________________________________________________________________________________
 Are you willing to participate in counselor training sessions? _______yes
________no
 Is your schedule free to be at camp the entire time (July 6-9)? _______yes
________no

Would you be able to attend the following counselor trainings?
_________March 2 (6:30-8:00 p.m.)
_________April 29/30(Camp Counselor Lock-In, 6:30pm to 8:30am)
_________May 20-21-22 Optional Leadership Club Camp
_________July 6-7-8-9 (Summer Slumber-Fort Stevens)
Do you have any special needs or limitations which may require special attention? ____ yes ____no
If yes, please explain: ___________________________________________________________________
_____________________________________________________________________________________

List any activities you have a certification card in:
First Aid
__________yes
___________no
Water Safety Instructor _______yes
________no
First Aid/CPR card
_______yes
________no
Other? Please specify _______________________

If yes, card expires on ________________
If yes, card expires on _________________
If yes, card expires on _________________
Please specify your skill and leadership ability in the following activities: 0=No Interest 1=No
Experience 2=Some Knowledge 3=Can Assist in Activity 5=Can Lead an Activity 6=Have an Interest
in but No Experience
Arts & Crafts
____General Crafty Things
____Tie Die
____Scrapbooking
____Leatherwork
____Beading
____Other: _______________________
Outdoor Skills/Science
____Archery
____Compass Reading
____Nature/Wildlife
____Fishing
____Bugs
____Robotics
____Rocketry
____Other: _______________________
Sports
____Swimming
____Soccer
____volleyball
____Outdoor group games
____Other: _______________________
Social/Special Skills
____Large Group Games
____Small Group Games
____Leading Songs
____Telling Stories
____Skits
____Guitar or other campfire instrument
_______________________
You will be scored on responses and neatness. Add add'l page if needed .
Summer Camp, 2016
Clatsop County 4-H, 2016
Page 2
Do you have any other skills or hobbies that would be appropriate for camp? If you do, please describe:
________________________________________________________________________________________
________________________________________________________________________________________
EXPERIENCE
A. Describe all camp counselor experience. List most recent experience first.
1. ____________________________________________________________________________________
2. ____________________________________________________________________________________
3. ____________________________________________________________________________________
B. List any other experience where you have been involved in a leadership role.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
C. List any experience you have had working with youth_________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
D. With what age group was this experience? (Circle) K-3 grd.
4-6 grd.
5-8 grd.
9-12 grd.
E. List any other positions (volunteer or paid) you have held where you worked with/or for people.
1. Person or Agency_______________________________________________________________________
Duty______________________________________________________________________________
2. Person or Agency_______________________________________________________________________
Duty______________________________________________________________________________
F. Have you attended any camps before? ______YES _____NO If yes, What did you like best about
your camp experience?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
G. If you have attended camps, list two suggestions on how to improve it.
________________________________________________________________________________________
Clatsop County 4-H, 2016
Page 3
Summer Camp, 2016
H. What qualities/characteristics do you have that would make you a good counselor? (List at least 2)
________________________________________________________________________________________
________________________________________________________________________________________
I. What goals do you have for yourself and the campers?_________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
J. Do you think you are a good role model for kids? Why or why not?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
K. Why do you wish to be a camp counselor?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
L. Have you been suspended or expelled from school in the last year? ___yes ___no. If yes, please explain.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
M. Are there any condiments/foods you can’t be around: We often use food in counselor gags.
________________________________________________________________________________________
________________________________________________________________________________________
Clatsop County 4-H, 2016
Summer Camp, 2016
Page 4
Camp Counselor Job Description
Responsibilities:
1.
Group supervision of campers with attention to all of the following: program, health, happiness,
discipline, cleanliness, safety, routine duties, character and skill development.
2.
Be concerned for the social adjustment of EACH camper.
3.
Help campers plan, carry out and evaluate projects and activities.
4.
Promote camper participation in ALL activities.
5.
Assist campers with housekeeping chores.
6.
Take turns with other counselors for various responsibilities.
7.
Teach or assist with camp programs as needed.
8.
Exhibit personal habits, health, dress, speech, table etiquette and relationships with
other staff that serve as a beneficial model to campers.
9.
Set a good example in ALL you do at camp. Camp is a fun learning experience.
10.
Work with the camp directors and other camp staff to iron out difficulties with
facilities, programs, counselors, and campers.
Counselor Rules and Regulations: In order to have a safe, healthy camp that is a good experience
for everyone, counselors will:
1.
Use appropriate language.
2.
Make sure you will stop any or non-verbal put-downs of others.
3.
Be mindful of nature (breaking of branches on live trees, picking protected
wildflowers/other plants, carving trees, killing or torturing animals, is not acceptable).
4.
Be mindful of property (no vandalism).
5.
Stop horseplay and rough housing when it begins
6.
Give discipline that can be carried out—no physical punishments.
7.
Abstain from the use of illegal substances.
8.
Use cell phones only during allocated times.
Summer Camp, 2016
9.
Enforce quiet times hours.
10.
Do not wear T-shirts, caps or clothing that advertise alcohol, tobacco or anything
offensive. Do not wear bandanas, hats or clothing that would suggest gang symbols or
membership.
Qualifications:
·
·
·
·
·
Completed 9th grade at the time of camp (8th grade for CIT’s).
Ability to work as a team member with other counselors and adult staff members.
Responsible, friendly, enthusiastic, patient and willing to learn.
Participation in counselor training.
Those 16 and older must fill out an OSU Background Check and have it turned in by the Lock-In.
As a 4-H camp counselor, I agree to fulfill the responsibilities listed above, comply with the rules and
regulations listed and meet the following behavior expectations:
Counselors will stay with their campers at all times (day and night) unless otherwise assigned.
____________
Signature
Date
I agree to permit my son or daughter to participate as a camp counselor under the direction of
the Extension Agent. I understand that I will be notified by an agent at the time of violation
of these rules and that my son/daughter may be dismissed from counseling at that time.
Parent Signature
Source: Clatsop County Extension, Oregon
Summer Camp, 2016
_____________
Date
RECOMMENDATION for 4-H CAMP COUNSELOR
I, __________________________________, am interested in being a camp counselor at 4-H
Camp this summer. The camping staff would like your input about my qualities to fulfill the
responsibilities of a counselor. Please comment on the following topics and return this form to me
or return to the OSU Extension office, Clatsop County at 2001 Marine Drive, Rm 210, Astoria, OR
97103. It needs to be returned by April 24 so it can be used at my interview. Thanks You.
1. How would you rate the applicant on the following:
2.
1. Above Average
2. Average
3. Below Average
Emotional maturity/judgment ___
Communication Skills ___
Respect for authority ___
Leadership abilities ___
Enthusiasm and energy ___
Flexibility ___
Self-confidence ___
Creativity ___ Interaction with others/younger person ___
Completion of project work ___ Handles stress ___
2. Overall attitude:________________________________________________
_______________________________________________________________
3. Strengths: ____________________________________________________
________________________________________________________________
4. Weaknesses:___________________________________________________
________________________________________________________________
5. Do you recommend this 4-H’er as a counselor? Yes_____
No _____
6. Additional Comments (Positive or Negative)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Signature ______________________________________ Date ________________
Summer Camp, 2016
Camp Counselor Check-Off List, 2016
Meeting Dates
_________March 2 (6:30-8:00 p.m.)
_________April 29/30(Camp Counselor Lock-In, 6:30pm to 8:30am)
_________May 20-21-22 Optional Leadership Club Camp
_________July 6-7-8-9 (Summer Slumber-Fort Stevens)
What do I need to bring:
April 29/30 Lock-In—MANDATORY
____Application-filled out and signed by you and parent/guardian
____Job Description-signed by you and parent/guardian
____Personal Reference-you can use the yellow form, or just a letter from them.
____Background check (every 2 years it needs to be redone for any youth spending the night
with youth in a leadership role)
Summer Camp, 2016