4-H Adventure Camp Counselor Program

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2 4-H Adventure Camp Counselor Program 4-H Adventure Camp Counselors have a unique opportunity to meet and work with teens, adults, and youth while having a fun outdoor experience and developing leadership skills. Camp Counselors are responsible for the safety and welfare of the campers during camp. This is not an easy job and should not be taken lightly. Successful camping experiences for campers depend on counselors being well prepared and working together as a team. Camp Counselor Requirements and Responsibilities Complete the Steps to Completing the Camp Counselor Certification Program Follow all University of Idaho and 4-H Adventure Camp Policies Be prepared and on time for all meetings and activities Attend all meetings Live in a cabin with a group of campers Be a positive role model to others Be able to meet the campers needs with the help of adults and other counselors Help campers understand and follow camp policies Promote camp to 4-H clubs and other organizations Actively participate in leading a workshop, class, or campfire Encourage camper participation in camp programs Participate in camp evaluation Help camp director and teen directors with various tasks and any changes in programming Be familiar with emergency procedures

3 Steps to Completing the Camp Counselor Certification Program: Return the completed application and counselor fee by Friday, January 15, 2016 Along with your application please answer the following question on a separate piece of paper: What makes a great camp counselor and how will you be a great counselor First year counselors: Schedule your interview when you receive the with the interview link. Enroll in 4-H and the Step Up to Leadership project Complete the Camp Counselor Focus Area Checklist Attend all planning and training meetings Attend camp and be an active participant Agree to perform the duties on the Requirement List Be familiar with emergency procedures Enter your project in your county fair First Year Counselors: CIT (Counselor in Training) Age: Completed 9th grade by camp dates or first year in program. Provide three character references Interview with Camp Director Counselors: Age: Completed 10th grade or higher by camp dates and two or more years in program. Instruct a workshop during a planning meeting/training Lead a team of counselors in a campfire, workshop, or activity

4 2016 Camp Dates and Deadlines Deadlines: ALL COUNSELORS applications are due Friday, January 15, 2016 FIRST YEAR COUNSELORS: Schedule your interview by January 27, 2016 Trainings: Basics: Saturday, February 20, 9:00 to Noon, Canyon County Complex, 1904 E Chicago, Caldwell All first year counselors must attend CIT Basics. Training Meeting/Planning Meeting: Saturday, March 12 Canyon County Complex, 1904 E Chicago, Caldwell Training Meeting/Planning Meeting: Saturday, April 9 Ada County Extension Office, 5880 Glenwood, Boise Training Meeting/Planning Meeting: Saturday, April 23 Ada County Extension Office, 5880 Glenwood, Boise Training Meeting/Planning Meeting: Saturday, May 14 Gem County Extension, 2199 S Johns, Emmett Camps: Counselor Retreat: Monday, June 6 to Wednesday June 8 June Kids Camp: Friday, June 10 to Monday, June 13 Teen Camp: Monday, July 11 to Friday, July 15 August Kids Camp: Friday, August 5 to Monday, August 8 Important Attendance Information: All counselors are expected to attend all trainings/planning meetings IN THEIR ENTIRITY. If you know you can t attend a meeting or have to come late or leave early, you must call the camp director at by 5:00 pm the day before the meeting. One excused absence or tardy/early leave will not count against a counselor for camp preference. Unexcused absences, tardiest, or early leaves for trainings or Counselor Retreat will be counted as an absence and may affect counselor s choice of camps or ability to attend camp at all. If you do not attend Camp Counselor Retreat it is at the discretion of the Camp Director if you can attend camp.

5 4-H Camp Counselor Application Name: Birthdate: Phone: Address: City: State: Zip: County: Grade: Years in 4-H: Years as Counselor: Parent Parent Consent: I herby give my permission for to attend Counselor Training activities at the time and place indicated and release the University of Idaho Cooperative Extension employees, sponsors, and volunteers from any liability connected with attendance. Date: Parent/Guardian signature: Participant Agreement: I understand that any of my behavior that jeopardizes the health, safety, or social well-being of any/everyone attending all functions of the 4-H Adventure Camp will result in my being dismissed from the activity, forfeiture of fees, and prompt return home at my expense. I also understand and agree to fulfill all requirements on the Steps to Completing the Camp Counselor Program and Requirements and Responsibilities Date: Participant signature: First time applicants only: List three persons other than relatives who can speak for your qualifications for this counseling position. Give complete address and phone numbers. These references will be contacted. Name: Phone: Relation: Address: City: State: Zip: Name: Phone: Relation: Address: City: State: Zip: Name: Phone: Relation: Address: City: State: Zip: Application Deadline: All Counselors Friday, January 15 Please return your application to: Ada County Extension 5880 Glenwood Boise, ID Camp Counselor Fee: $100* payable to District II 4-H Camp due with application * Counselor fee is non refundable * This fee does not include 4-H enrollment fees, which vary by county. *Sweatshirts: are optional and at an additional cost Step Up to Leadership book is included for first year counselors In compliance with the Americans with Disabilities Act of 1990, those requesting reasonable accommodations need to contact Dianne Hobbs at least one week prior to the event at , 5880 Glenwood, Boise, ID 83714

6 4-H Adventure Camp Health Form CAMPER MAY NOT REGISTER WITHOUT HEALTH FORM Counselor Adult Staff Teen Camp June Kids Camp August Kids Camp Name: Birthdate: Sex: Parent or Guardian: Camper Social Security #: Home Phone: Work Phone: Cell Phone: Address: City: Zip: If not available in emergency, notify: Address: Phone: HEALTH HISTORY: Please give approximate dates camper has had or received the following: Convulsions Hypertension Ear Infections Diabetes Bleeding/Clotting Disorders Ivy Poisoning Asthma Heart Defect/Disease Insect Stings Seizures Surgery Injury Chicken Pox: DPT immunization MMR immunization Allergies (Please list any allergies to bee stings, food, medications, etc): Operations or serious injury (dates) Chronic or re-occurring illness and treatment which may be needed while at camp: Dietary modification/preferences (including vegetarian): Current medications: Any specific activities to be restricted: Please list any special considerations you feel we need to be aware of (such as bed wetting, car sickness, sleepwalking) This information is confidential: Name of Family Physician: Phone: IMPORTANT: PLEASE NOTIFY THE CAMP OF ANY EXPOSURE TO INFECTIOUS DISEASE IN THE TWO WEEKS PRIOR TO CAMP. PARENT AUTHORIZATION: To my knowledge this health history is correct so far as I know, and the person herein described has permission to engage in call Camp activities except as noted. I hereby give permission to the physician by the 4-H Camp to order x-rays, routine tests, and treatment for the health of my child, and in the event I cannot be reached in an emergency, permission to secure proper treatment for, hospitalization, order injection, and/or anesthesia and/or surgery for my child as named above. Signature of Parent or Guardian: Date: CAMPER AGREEMENT: I also understand and agree to abide by the restrictions placed on my activities and agree to assist 4-H Camp staff in my health care. Signature of minor camper: To enrich education through diversity the University of Idaho is an equal opportunity/affirmative action employer and educational institution. Persons with disabilities who require alternative means for communication or program information or reasonable accommodations need to contact Dianne Hobbs at by two weeks prior to this event.

7 CASCADE LAKE 4-H CAMP Donnelly, ID WAIVER OF LIABILITY & INDEMNITY I am the legal guardian for, a minor ( Child ), who will be at the Cascade Lake 4-H Camp provided by Cascade Lake 4-H Camp, Inc. ( 4-H Camp ), participating in camping, use of the Cascade Lake Reservoir, and other activities ( Activities ). As lawful consideration for the intangible value that the Child will gain by participating in the Activities, I agree to all the terms and conditions set forth in this agreement ( Agreement ). I am aware and understand that the Activities are dangerous and involve the risk of serious injury, death, or damage of property brought to the 4-H Camp. I acknowledge that any injures that the Child sustains may be caused or compounded by negligent emergency response or rescue operations of the 4-H Camp. I acknowledge the danger involved and agree to accept and assume any and all risks of property damage, injury, or death of the Child whether caused by the negligence of the 4-H Camp or otherwise. I understand that the Cascade Lake 4-H Camp, Inc. and its volunteer board of directors and employees do not plan or supervise the Child s activities and are not responsible for my Child s safety and well being while at the 4-H Camp. I understand that my Child s activities at the 4-H Camp are planned and supervised by the camping director of the group he/she is camping with, and that the camping director is responsible for my child s safety and well being during the camping period. I further understand the 4-H Camp, Inc., its volunteer board of directors or employees will not be liable for any injury that my Child may incur while participating in the Activities in or on the water or at the 4-H Camp during my stay. I expressly waive and release all claims, including future claims, against the 4-H Camp, its officers, volunteer board of directors, employees, agents, and its successors and assigns ( Releasees ) on account of injury, death, or property damage arising out of my Child s participation in the Activities, whether or not attributable to the negligence of the 4-H Camp or any Releasee. I forever release and discharge the 4-H Camp and other Releasees from liability under or related to these claims. I agree to defend, indemnify, and hold harmless the 4-H Camp and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including attorney fees, fees, and the costs of enforcing any right to indemnification under this Agreement and the cost of pursuing any insurance providers, incurred by or awarded against the indemnified party, arising out of or resulting from any claim of a third party related to the Activities, whether caused by negligence of the Releasees or otherwise. This Agreement constitutes the entire agreement of the 4-H Camp and me with respect to my Child s participation in the Activities at the 4-H Camp. This Agreement is binding on and shall inure to the benefit of the 4-H Camp and me and their successors and assigns. All matters arising out of or related to this agreement will be governed by the internal laws of the State of Idaho, without giving effect to any choice or conflict of law provision. Any claim or cause of action arising out of this Agreement may be brought only in the federal and state Courts located in the state of Idaho, county of Canyon. By signing this Agreement, I acknowledge that I have read and understand all of the terms of this Agreement and that I am voluntarily giving up substantial legal rights, including the right to sue Cascade Lake 4-H Camp, Inc. Printed name of guardian Date Signature of guardian Phone Medical alerts Cascade Lake 4-H Camp is operated in accordance with USDA policy which prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disabilities, and political beliefs. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA s TARGET Center at (202) (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Bldg, 14 th and Independence Avenue, SW, Washington, DC or call (202) (voice and TDD). USDA is an equal opportunity provider and employer. 1/14

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