February 8, 2019 Cooperative Extension Service Clark County 1400 Fortune Dr Winchester, KY 40391 859-744-4682 Fax: 859-744-4698 http://extension.ca.uky.edu Potential 2019 Summer 4-H Camp Adult Counselors: Clark County 4-H will be camping June 3-7, 2019, and we would like to invite you to apply to be an Adult 4-H Camp Counselor. Camp is an opportunity for youth to learn life skills in a high energy, fun-filled week. Campers make memories that last forever. We cannot provide this amazing experience without dedicated volunteers like you! Our goal is to not leave any campers at home, but that requires your help! Sign-up to attend camp and your child goes to camp for free! Returning Adult Counselors will be background checked yearly using previous years background check information in your volunteer file. If anything as changed please let us know immediately. New Adult Counselors must complete a new volunteer application, pass a background check and must be interviewed prior to being accepted as a volunteer. Please note: New Adult Counselors are accepted on need basis (depending on number of returning counselors and number of campers attending camp). Mark your calendar with the following dates: Application Deadline: Friday, March 15 by 4:00 pm Interviews: New Volunteer Interviews Scheduled Individually All- Counselor Orientation: Saturday, May 25 at North Central 4-H Camp Camper Orientation: Tuesday, May 28 (evening) Camp: June 3-7, 2019 Please contact the Clark County Extension office at (859) 744-4682. Sincerely, Shannon Farrell Clark County Agent for Clark County Agent for 4-H Youth Development 4-H Youth Development
COUNSELOR NAME 4-H Summer Camp Application Packet 2019 June 3-7, 2019 ADULT Clark County Extension Office 1400 Fortune Dr. Winchester, KY 40391 (859) 744-4682 Due by March 15, 2019 no later than 4:00pm! Read carefully and fill out each section: Fill out/sign/date Registration/Health Form for Adults (2 pages) (Read each section carefully and complete all boxes) Insurance Card (photo copy of card, front and back, TAPED to application) Read/Sign/Date Camp Notification Policy Read/Sign/Date Volunteer Expectations Read/Sign/Date Camper Code of Conduct New Applicants: Fill Out/Sign/Date Volunteer Application Packet Returning Counselors: previous year s application will be used for current year s background check. Read/Sign/Date Adult Camp Counselor Position Description Placed following dates on my calendar: All Counselor Orientation: Saturday, May 25, 2019 at North Central 4-H Camp Camper Orientation: Tuesday, May 28, 2019 at Extension Office 4-H Summer Camp: June 3-7, 2019 APPLICATION RECEIVED BY: Date:
Kentucky 4-H Camping 2019 Camp Participant Registration Adults (Age 18+) Last Name: Legal First Name: Middle Name: Preferred Name: Attended camp before? Yes - # years: No Shirt Size: (Circle One) Gender Identity: Male Female Cell Phone Number: Physician s Name: Email Address: Physician s Phone Number: AS AM AL AXL A2XL A3XL A4XL Participant s Home Address: Street City, State, Zip Participant s Race: White Black Asian American Indian Hawaiian Cannot be determined Other Participant s Ethnicity: Hispanic Non-Hispanic Emergency Contact Name: Relationship to Participant: Cell/Home Phone: Are there any specific behaviors, medical needs, dietary needs, accommodations, or information which the staff should be made aware of to provide a better camp experience for the participant? Does the participant have health insurance coverage? YES (Attach a copy front and back of the insurance card in the boxes below. Use tape; DO NOT staple.) NO (No worries! Camp provides excess medical insurance coverage in the event of injuries or illnesses.) FRONT OF INSURANCE CARD BACK OF INSURANCE CARD
PARTICIPANT NAME: AUTHORIZATIONS/RELEASES This is a legal document. You must read and understand it before signing. MEDIA RELEASE: I grant the Kentucky 4-H Program and the University of Kentucky, Kentucky State University, and persons acting through them, the right to use, reproduce, assign, and/or distribute photographs, films, videotapes, and sound recordings of me without compensation for use in promotions/advertising, educational publications, electronic publishing, and personal memorabilia. Participant names may be published. CONSENT TO TREAT: I hereby permit the camp to provide routine health care, administer over the counter medication, assist in administering participant s prescription medications as needed, and seek emergency medical treatment including ordering x-rays and routine tests. I agree to the release of any records necessary for treatment, referral, billing, or insurance purposes. I permit the camp to arrange necessary related transportation for me. I hereby permit the physician selected by the camp to secure and administer treatment, including trips off camp property. CODE OF CONDUCT: I have read and reviewed the adult volunteer position description and volunteer expectations. I understand and agree to comply with the guidelines. Violations may result in loss of privileges, removal from camp with no refund, assessment of a damage fee for which I will be responsible for paying, and/or ineligibility to participate in future 4-H events. An incident report will be completed for major violations. ASSUMPTION OF RISK, RELEASE OF LIABILITY, and PERMISSION TO PARTICIPATE: I acknowledge that there are certain risks, hazards, and dangers, including the risk of physical injury, disability, or death and risk of loss of use or damage to my personal property as a result of allowing participation in the camping program. Risks include but are not limited to recreational games and traditional camp activities, transportation accidents, weather-related hazards and natural disasters, infectious diseases, the possibility of slips and falls, pinches, scrapes, twists, and jolts that could result in scratches, bruises, sprains, lacerations, fractures, concussions, or even more severely debilitating or life-threatening hazards. I understand that injury or loss may result from unknown or unexpected risks and the use of equipment, materials, or facilities recommended by the University of Kentucky; environmental conditions; from the acts or omissions of others; or from the unavailability of immediate and adequate emergency medical care. I understand that the University of Kentucky does not guarantee the personal health or safety of participants, nor does it protect against the risk of loss of personal property. In consideration for participating in the camping program, I do hereby release Kentucky 4-H Camp, the University of Kentucky, Kentucky State University, and its members, trustees, officers, employees, independent contractors, volunteers and extension staff from any and all liability, damages, cost, and expenses arising out of or relating to bodily or psychological injury, loss of life, or personal property that may occur as a result of participating in the camping program. I understand that my participation in the Kentucky 4-H Summer Camping Program is based on the challenge by choice philosophy. I recognize that programs are designed to use experiential, engaging teaching techniques, but that my participation is purely voluntary, always, and I will choose my level of participation in any activity (including, but not limited to: high ropes, rock climbing, low challenge elements, rifles, archery, trap shooting, horses, and cave exploration). Participant Signature: Date: Are you looking to buy some camp gear? www.4hcampstore.com Are you looking for more volunteer opportunities? www.4hcampevents.com
Expectations for Volunteers Kentucky CES Expectations for Volunteers Trust is placed in the Kentucky Cooperative Extension Service to provide quality leadership and care for individuals participating in CES programs. The opportunity to work with youth is a privileged position of trust that should be held only by those who are willing to demonstrate behaviors that fulfill this trust. These expectations for volunteers guide their involvement in Kentucky Extension activities. The purpose of these expectations for volunteers is to ensure the safety and well-being of all participants (i.e., youth, their parents and families, paid and volunteer staff). Kentucky CES volunteers are expected to function within the guidelines of Kentucky CES and Kentucky 4-H. The following statements relate to the role of a volunteer with Kentucky CES and represent a contractual agreement between a volunteer and Kentucky CES. I will represent Kentucky CES to youth and adults by conducting myself with courteous manners and language, exhibiting good sportsmanship, serving as a positive role model, and demonstrating appropriate conflict resolution skills. I will abide by all applicable laws and CES rules, policies, and guidelines. This includes, but is not limited to, child abuse, fiscal management procedures and substance abuse. I will accept supervision and support from Extension staff or management volunteers. I will participate in orientation and on-going volunteer education and development, including client protection standards. I will not consume or allow others to use alcohol or illegal drugs at any CES function. I will, when transporting others, operate vehicles and equipment in a safe and reliable manner and only with a valid operator s license. I will comply with all vehicular regulations and laws. All passengers will be secured by properly operating seat belts. I have the minimum vehicle insurance coverage required by the Commonwealth of KY. I will accept the responsibility to promote and support the vision, mission, and values of Kentucky CES and its programs. I will conduct myself in a manner that is in the best interest of youth, adults and CES and will not use the volunteer position for purposes of personal gain. I will treat animals in a humane manner and teach program participants to provide appropriate animal care and management. I will use technology (including social media) in an appropriate manner that reflects the best practices in youth development. I will not practice, condone, tolerate or allow bullying, hazing, harassment or malicious pranks. I will ensure that educational programs of Kentucky CES shall serve all people regardless of race, color, age, gender, religion, disability or national origin. I have read, understand, and agree to abide by these expectations for volunteers. I understand that suspension or termination of my position will result if I do not meet these expectations. Signature of Volunteer Date Signature of County Agent Date
Kentucky 4-H Camping Program Camper Code of Conduct / Expectations OM-4, 9 1. Possession or use of alcohol or illegal drugs by any person involved in the 4-H Camp Program is strictly prohibited. 2. Any weapon or article construed to be a weapon, hunting or pocket knife must be checked in with the Extension Agent from the camper's county upon arrival at camp. These items may be returned at the end of camp. The best prevention is to leave these items at home. 3. Use of tobacco products is not allowed for campers/teens at 4-H camp. Should a county(s) decide to permit adults (18 years and over) to use them, it may occur only in areas designated by the Camp Director. Absolutely no tobacco products in cabins, woods or other areas of camp. 4. Boys and girls cabin areas are restricted. A camper of the opposite sex is not, at any time, to enter a restricted area unless approved by the Camp Program Director. 5. Campers are not allowed in the cabins during a class or activity. If a camper is ill, he/she is to stay at the medical center (not in a cabin) until the Health Care Provider (HCP) feels the camper may return to activities. 6. There is to be no visitation to friends in cabins. 7. Campers are to be attentive, responsive and courteous to any staff, adult or teen counselor making a presentation before the group. 8. Absolutely no phone calls are to be made by campers (camp phone or cell phone) without approval of the County Extension Agent. All County Extension Agents should be informed of incoming calls to campers. 9. Campers are not permitted to bring cell phones to camp. 10. Accidents or illnesses, no matter how minor, are to be reported to the HCP and County Agent. 11. Obscene, discriminatory and/or inappropriate language or dress, roughhousing, and insubordination is not acceptable at any time during camp. 12. Fireworks are not to be used by campers at any time during camp. 13. Swimming, boating, or any waterfront activity is not permitted except during designated times and under proper supervision. 14. Appropriate dress, including footwear, should be adhered to as outlined at camper orientation. 15. Campers are always to remain with their groups. Individuals are not to be on the trails or near the lakes without an accompanying adult. 16. Campers are not permitted to leave the grounds at any time without notifying and receiving approval from the Camp Program Director and their County Extension Agent. 17. All campers are expected to be in their cabins, with lights out, as designated on the camp program. 18. No visitors, other than parents or immediate family, may visit campers during the camp. 19. No camper is to be around or on maintenance equipment parked or being used on camp property. 20. Campers who are having personal conflicts with other campers are encouraged to discuss these with their cabin counselor, dean or County Extension Agent. 21. Campers are to work with counselors in carrying out daily assigned jobs to help keep the camp running smoothly. Grounds are to be kept clean at all times. 22. Campers are expected to leave the cabins, facilities and grounds clean and orderly. 23. Campers are to respect camp property. Any malicious or intentional damage to camp property or buses shall be paid for by the camper and/or parent or guardian, including graffiti on any camp property.
24. All medications must be turned in to the designated adult and picked up by the parent/guardian at the bus pick up site. The Health Care Provider will be responsible for securing all medications at camp. 25. Electrical appliances (hair dryers, curling irons, etc.) are to be used in cabins only; not in restrooms. 26. Camp is not responsible for personal property of any camper, volunteer or staff. 27. We care about the safety of your child, incidents of serious misbehavior (i.e. fighting, bullying, causing injury, alcohol/drug incidents, any altercations between adults and/or minors, intentional property damage/vandalism, etc.) will be reported to the Camp Director and an incident report will be completed. 28. Campers should demonstrate respect toward others. Bullying, hazing or malicious pranks (i.e.: shaving cream, toothpaste in pillow/sleeping bags, defacing property, including inappropriate use of electronics/social media) will not be tolerated and may result in the perpetrator(s) being sent home. 29. Any conduct inconsistent with the above rules may result in consequences such as the camper/family/friend being sent home, restricting future participation in 4-H activities, termination of 4-H membership, or other consequences determined by the county s or state s policy. 30. If a camper must be sent home, it will be the responsibility of the parent/guardian to pick him or her up at camp. There is no refund of the camper fee for an early departure. Camper/Volunteer Signature Parent/Guardian Signature Date
Clark, Mason, & Montgomery Camp Notification Policy Notification of Changes Parent(s)/guardian(s) listed on the camp form will be notified of changes from the schedule as indicated through text messages and/or telephone calls. Parents will be notified (using the first number provided on the custodial/guardian line of the campers form) of any changes in time or location on the departure day and the arrival day. Please be sure that the number you provide us is a phone number at which you can be reached at any time. Injury/Illness Parents will not be notified of every bump, bruise, or minor illness. Parents will be notified when the Health Care Professional deems it necessary and/or off-site medical treatment is needed. Emergency Policy If an emergency situation arises that directly involves a camper, parent/guardian(s) of the camper will be notified by one of the 4-H Agents or their designated representative at a time deemed appropriate and safe by the agents. Cell Phones Campers are not permitted to have cell phones while at camp. Being at camp includes transportation to and from camp. Parents will not be notified when a camper has their cell phone confiscated. Phones that are confiscated will be turned off, placed in a safe storage, and returned to the camper upon return from camp. Disciplinary Issues The Clark, Mason, or Montgomery County 4-H Agents will be consulted on all disciplinary issues by the teen leaders/adult leaders. Camp rules must be followed. A camper s or teen leader s parent/guardian will only be notified of any flagrant violation of camp rules. A flagrant violation will result in the camper/teen leader being sent home and must be picked up at camp by parent/guardian or someone from their pick-up/release list. Refusal to Pick Up Camper/Teen Leader When a parent/guardian is notified that they need to come to camp and pick up their camper/teen leader, they must do so in a timely manner. The agents don t make the decision to send someone home (either for illness or discipline) unless it is absolutely necessary. In a timely manner should be within a four hour window of first being notified. Failure to pick the camper/teen leader up in a timely manner may result in the local child services being called. Also, on the return day from camp, an approximate time is given in the orientation packet. Failure to pick-up (within two hours of estimated time of arrival or actual arrival time, whichever is latest) camper/teen leader by someone from the pick-up list provided by the parent/guardian may result in local child services being called. I have read and understand the above policy. Parent/Guardian/Adult Volunteer Date
4-H ADULT CAMP COUNSELOR VOLUNTEER POSITION DESCRIPTION: Kentucky 4-H Youth Development Program Kentucky Cooperative Extension The University of Kentucky College of Agriculture, Food and Environment POSITION TITLE: 2019 4-H Adult Summer Camp Counselor TIME REQUIRED / DURATION OF APPOINTMENT Complete application materials and background check by Friday, March 15, 2019 Read Adult Orientation Materials and attend Counselor Orientation Saturday, May 25, 2019 Attend Camper Orientation, Tuesday, May 28, 2019 Five Days and Four Nights of Camp (Monday-Friday, 24 hours a day), June 3-7, 2019 LOCATION: Counselor and Camper Orientations held at the Clark County Extension Office Camp at North Central 4-H Camp near Carlisle, KY in Nicholas County GENERAL PURPOSE: Help supervise 12-16 youth, ages 9-13 and Junior Counselors, in a camping setting Support 4-H professionals, volunteers, Junior Counselors and members in conducting meaningful educational experiences to help youth develop social skills. SPECIFIC RESPONSIBILITIES: Be committed to young people and their development Involve campers in all scheduled activities while at camp, and assume campers are on time for programs Supervise group living environment (i.e. housekeeping, personal hygiene, social skills, responsibility, sharing, following rules) Participation in camping activities, and encourage all campers to join Counsel homesick campers Follow all guidelines and policies of the University of Kentucky 4-H program Recruit campers Actively participate in the program planning and implementation for the week Encourage campers to try new activities
QUALIFICATIONS: Must complete the Kentucky 4-H volunteer application and screening process and be accepted by the Youth Protection Committee. Must provide own transportation to meetings and activities. Self starter; be able to work with minimal supervision from professional staff. Effective communication skills. A sincere interest in working with extension staff, volunteers, parents, and youth. Organizational skills; ability to organize information and materials in a timely manner. Must be 18 years old or older Complete Health form A willingness to become familiar with and work with the philosophy and guidelines of the University of Kentucky CES, Kentucky 4-H program and county 4-H program BENEFITS: The opportunity to work with youth and/or adults providing support and growth experiences Receive intrinsic rewards at volunteer recognition events Volunteer development opportunity Opportunity to share your skills, talents and interests Orientation provided by Extension staff Research shows that volunteering promotes improved health The opportunity to make a difference in the life of the child. SALARY: Unsalaried; volunteer. MENTOR/SUPERVISING PROFESSIONAL Shannon Farrell and Brandy Calvert Clark County Agents for 4-H Youth Development 1400 Fortune Drive Winchester, KY 40391 859-744-4682 I have read, understand and agree to fulfill the purpose and responsibilities of this volunteer position and further agree to accept guidance and direction from the supervisor. I also understand that failure to fulfill the purpose and responsibilities of the volunteer position and to accept guidance and direction from the supervisor could result in suspension of my position. I also understand that this volunteer position is renewable annually; I will notify the supervising professional if I am no longer interested in serving. Adult Counselor Signature Date Supervising Agent Signature Date