Due: First Friday in December
Name:
Address:
Phone:
Age: (as of 1/1/13)
Cell:
Grade: (as of 1/1/13)
Club:
Email:
NOTE: To apply for Camp Counselor, you must be in grades 10-13. You will be required to attend 10 hours of annual Camp
Counselor Training and stay at camp throughout the program. We camp with Marathon, Wood, and Clark Counties.
I would like to help with:
Lead Group Singing
Arts & Crafts
Other: Please explain
Swimming/Water Games
Evening Programs
Field Recreation
Campfire Programs
Please answer the following questions:
1.
Why are you interested in being a Camp Counselor? (Provide at least 3 reasons).
2.
What qualities do you have that would make you a good Camp Counselor?
3.
Have you had experience working with groups of youngsters before? If yes, please describe.
4.
If you have been camping before, describe what you liked most about your experiences and why.
5.
List your hobbies, interests, or other special skills that relate to being a Camp Counselor.

Each year the Camp Counselors and Adult Staff select a timely and fun camp theme around which to build camp activities and programs. Remember, Upham Woods is an Environmental Education Center. After giving the topic of “theme” careful thought, complete the following camp plan. At a minimum, give a camp theme and group name ideas.
CAMP THEME:
CRAFT IDEAS RELATED TO THE THEME:
SPECIAL PROGRAMS, SESSIONS, ACTIVITIES, OR SPEAKERS RELATED TO THE THEME:
RECREATION IDEAS RELATED TO THE THEME:
FOOD/SNACK IDEAS RELATED TO THE THEME:
OTHER SUGGESTIONS:
POTENTIAL COUNSELOR/PARENT UNDERSTANDING
I understand that camp counselors are responsible for helping to plan, promote, conduct, and evaluate camp. I also understand that campers view me as a role model. It is important I set a positive example with my attitude, words, actions, and appearance.
I promise to fulfill my responsibilities as a camp counselor and a role model to the best of my abilities, and if I am selected as a 4-
H Camp Counselor, I will attend the required training sessions on dates to be announced, follow and support the camp philosophy and rules, and participate fully at camp.
Applicant Signature Date
I am aware of my son/daughter’s interest in being a 4-H Camp Counselor and understand that he/she is assuming, with supervision from the County Extension 4-H Agent, a serious responsibility for other people’s children. I support his/her participation in this activity.
Parent/Guardian Signature Date
Please return completed applications by First Friday in December to:
Juneau County Extension: 4-H Youth Development, 211 Hickory Street, Room 302, Mauston WI 53948