Camp Patterson 4-H Camp Counselor Application 2016
Due to your County Extension Office by Friday, February 26, 2016
Please Check Box: ☐ New Counselor
☐ Returning Counselor # of years:
Name:
Cell Phone:
Address:
Age:
City:
Grade:
Parent/Guardian:
Your email:
State:
County:
Zip:
T-Shirt Size:
Parent Cell Phone:
Parent email:
Camp Counselor Training
If you are chosen to be a camp counselor you will have 2-3 trainings that you are required to attend.
The first camp counselor training will be held on three different dates in 3 different locations. In order to be a camp
counselor you MUST be able to attend this first training. We would like you to attend the training session for the
camp you will be working with, but if that date does not work due to scheduling conflicts, you can choose a
different training site.
Please (X) the training that you are able to attend:
NOTE: Camp Counselor Training for Saturday April 2 and Saturday April 9: 9:00 a.m. - 3:00pm. Camp Counselor
Training for Sunday April 3 – starts at 7:00 p.m.
_______ Saturday, April 2, 2016 – Session 1 (Blue Earth, Brown, Faribault, Nicollet, Le Sueur) Location: Mankato
_______ Saturday, April 2, 2016 –Teen Camp (All Teen Camp Counselors) Location: Mankato
_______ Sunday, April 3, 2016 – Session 3 (Carver, Scott, McLeod, Sibley) Location: Scott County Extension Office
_______ Saturday, April 9, 2016 – Session 2 (Freeborn, Mower, Rice, Steele, Waseca) Location: Owatonna
If you are not able to go to the training for your camp session please explain why:
Please check which session of camp you would like to be a counselor for. You must have completed 9th grade by
summer 2016 to be a counselor for youth camp, and completed 10th grade by summer 2016 to be a counselor for Teen
Camp.
Please mark your choices in order of what would work for you (Rank 1-4, with 1 being your first choice).
YOUTH & TEEN CAMP
_______ SESSION 1 Grades 3-6: Monday, June 6th – Wed., June 8th (Blue Earth, Brown, Nicollet, Faribault, Le Sueur)
_______ SESSION 2 Grades 3-6: Wednesday, June 8th – Friday, June 10th (Freeborn, Mower, Rice, Steele, Waseca)
_______ SESSION 3 Grades 3-6: Monday, June 13th – Wed., June 15th (Carver, Scott, McLeod, Sibley)
_______ TEEN CAMP Grades 6-8: Wednesday, June 15th – Friday, June 17th
(Blue Earth, Brown, Carver, Faribault, Freeborn, Le Sueur, McLeod, Mower, Nicollet, Rice, Scott, Sibley Steele, Waseca)
Yes ______ No _______ If you chose a youth camp and teen camp, would you be willing to attend both camps?
1. Have you been a counselor before? If yes, when and where?
2. Have you attended 4-H camp before? If so, please describe your experience (what you learned, what you
enjoyed most, etc.).
3. Why do you want to be a counselor?
4. Please describe other youth leadership experiences you have had in your club or county, within 4-H or outside of
4-H.
5. What makes you the best applicant for a camp counselor?
6. What contributions do you feel you can make to camp?
7. Have you had experience in leading or being in front of large groups of people? If so, please list and describe
your experience.
What are some of your skills/talents?
☐ Play a musical instrument (List instrument)
☐ Certified in First Aid (Date of certification)
(Attach Copy of Certification)
☐ Life Guard (List Level)
(Attach Copy of Certification)
☐ Other (Please list)
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).
Reference #1
Name: _________________________________________ Relationship: _________________________________
Phone Numbers: (Home) ___________________________________ (Cell): ______________________________
Email Address__________________________________________________________________________________
Reference #2
Name: _________________________________________ Relationship: _________________________________
Phone Numbers: (Home) ___________________________________ (Cell): ______________________________
Email Address__________________________________________________________________________________
Youth Commitment:
As a camp counselor I commit myself to:
 Attend camp counselor trainings.
 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 off-color jokes or stories.
 Never punish a camper by ridicule or physical punishment – patience and understanding works wonders.
 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 that 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 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 respect 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 being out of my cabin after hours and/or the possession or use
of tobacco, alcohol, or illegal drugs.
________________________________
_______________________
(Youth applicant signature)
(Date)
Parent/Guardian Commitment:
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.
_____________________________________
(Parent/Guardian Signature)
____________________________
(Date)
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