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2019 4-H Summer Camp Chaperone Registration

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Santa Clara County 4-H

2019 Summer Camp Chaperone Application

Camper dates: Tuesday, June 11 through Saturday, June 15, 2019

Youth Staff dates: Monday, June 10 through Sunday, June 16, 2019

Camp Butano, Pescadero, California

There is NO camp registration fee for chaperones. If you have any questions, contact the director team at




Please mark all the days you are available.


At camp, we have three "Campers’ Choice" times per day when we organize activities such as campfire cooking, rifle shooting, hikes, archery, astronomy, botanical science, arts and crafts, and other outdoor fun activities. We strongly encourage (but do not require) our chaperones to help out with activities. Do you have skills or hobbies that you might be able to share with campers during “Campers Choice”? Do you have an area that you enjoy more than others? 


Each year, we are required to provide an emergency plan for our stay at Camp Butano. Please answer the following questions to assist us with this report.

Medical Treatment Authorization Forms:

It is not required that you provide a paper Medical Treatment Authorization Form.

PLEASE DO check that your 4-H online profile is up to date and current with any changes in your medical information. 

These online forms will be printed and provided as a resource to the health officer for 4-H Summer Camp.

A map and information on what to bring to camp will be mailed to you shortly before camp starts

For verification that you are human, please enter the following code in the box below:

(if the code is not entered correctly, the survey will not be submitted)