4-H Camp Counselor Application- 2020

Plumas-Sierra County 4-H

Camp Counselor Application

camp dates: June 15-19, 2020

Please complete and submit this application by January 27th

Once submitted, we will let you know if you've been selected by Early February

✻ = Required

Name

Email ✻

Phone number

Address

Grade

9th 10th 11th 12th

Age

Would you consider being a life guard if training was provided?

Yes No

What are some activities you'd like to see offered at camp this year?

Are you a 4-H club member?

Yes No

Have you ever attended 4-H camp as a camper or counselor?

Yes No

Certified Lifeguard?

Yes No

First Aid certified?

Yes No

CPR certified?

Yes No

Have you ever received any training or have any experiences which you feel help qualify you to be a camp counselor? Please include your experiences with leadership roles.

What do you think are important qualities for a camp counselor to have?

What special interests do you have?

Why do you want to be a camp counselor?

If selected as a camp counselor, will you be able to refrain form any drug and alcohol use at camp?

Yes No

If selected as a camp counselor, will you be able to refrain from any romantic/physical relationships while at camp?

Yes No

List two references

Reference 1 Name:

Reference 1 email/phone:

Reference 2 name:

Reference 2 email/phone:

Thank you for your time and interest! Please submit your survey and we will contact you soon!

Questions? email Kari at koreilly@ucanr.edu or Samantha at sbusselen76@pcoe.k12.ca.us