Please return applications to: Boone County Extension Office 1012 N Hwy UU Columbia, MO 65203 2018 4-H Counselor Camp Application Due January 23, 2018 Counselor Camp Registration Fee is $60 Due February 19 Make checks payable to Boone County 4-H Sr. Council Counselor Camp, June 1-2 Clove Point Camp, June 11-14 Name County 4-H Age of Birth Male Female Address City Zip Phone Cell Phone Email Parent s Email T-shirt Size Small Medium Large X-Large 2X-Large Camps Needing Counselors (Check all you are interested in attending): Canine Camp (June 7-9) Traditional Camp (June 11-14) Shooting Sports Camp (June 21-23) (4-H members ages 8-13) (4-H members ages 8-18) Are you be interested in serving as a 4-H Camp Lead Counselor (see pg. 6 for more info)? Yes No Have you attended 4-H Camp before? Yes No List years attended: Have you been a 4-H Camp Counselor before? Yes No List years attended: Are you certified in CPR? Yes No List expiration date: What age children do you prefer to work with? - - -13 What camp duties/activities would you prefer to work with? Short Answer: Please answer the following questions on a separate piece of paper (do not exceed 1 page total). 1. Describe previous experiences when you ve had success working with children. 2. Describe previous experiences that have helped you develop your leadership skills. 3. Describe the qualities that make you a strong camp counselor candidate and how you would use them. 1
IMPORTANT DATES TO REMEMBER Camp Counselor Training (Mandatory Attendance) Monday, February 19, 2018 8:30am-5:30pm; Boone County Extension Office Camp Counselor Wrap Up Wednesday, March 7, 2018 5:30pm-8:00pm; Howard County Extension Office Counselor Camp June 1-2; Camp Clover Point 4-H Camp June 11-14; Camp Clover Point Canine Camp June 7-9; Camp Clover Point Shooting Sports Camp June 21-23; Camp Clover Point CAMP COUNSELOR AGREEMENT I understand that completing this form does NOT guarantee that I will be selected as a 4-H Camp Counselor in 2018. I further understand that candidates that best fit the volunteer counselor staffing needs of 4-H Camp, as determined by Camp Counselor Interview Committee, will be selected. I understand that I may be designated as an alternative and could be asked to step up in the role of Camp Counselor at anytime (sickness, injury, influx of campers, etc.) I understand that because I am filling out this application, I am expected to attend the mandatory counselor training on February 19, 2018. If I cannot attend the counselor training I understand that I must contact my Youth Specialist/YPA prior to that time to discuss alternatives. I understand that my 4HOnline profile must be updated by May 1 st with current health and family contact information. Youth Signature Parent/Guardian Signature CLUB LEADER SECTION I verify that is a member in good standing with the 4-H Club in County. Signature of Club Leader: Furthermore, I agree that this individual will be a positive role model and meet the qualifications needed to perform the duties of Camp Counselor. 2
CAMP CLOVER POINT TECHNOLOGY AGREEMENT The University of Missouri Extension 4-H Youth Development Programs coordinates 4-H education events and activities, such as 4-H Camp. All youth participants must observe the following guidelines for technology use: 1. I agree not to use the camp name, logo, or photograph without prior written approval from the camp. 2. I agree not to create a website, group page, profile, etc. of camp using photographs or text of/about campers, counselors, or staff. 3. I agree to be respectful of the camp, its programs, campers, counselors, and staff in all communications. This includes: a. I will not swear or use obscene gestures of any type. b. I will not use harassment, bullying, or intimidation in any way. c. I will not post comments that are negative or make fun of a person in any way. d. I will not participate in sexually explicit, suggestive, humiliating, or demeaning comments on any communication method. 4. I will not bring a cell phone to camp. Any phone brought to camp will be collected by the staff upon arrival at camp and returned at the end of camp. 5. I will not bring ANY form of technology to camp. Any technological item brought are for use on the bus only and will be collected by the staff upon arrival at camp and returned at the end of camp. 6. I will NOT bring a digital camera or video camera to camp. If you would like to take pictures at camp you may bring a disposable film camera (with an affixed return address label). The first afternoon of camp, campers (with counselors present) will be allowed to take pictures of their bunk area inside their cabin. For the remainder of camp, only outside pictures are permitted. We will provide you with your counselor s mailing address if requested. Any other contact including email addresses, IM screen names, cell phone numbers, social networking profiles, blogs, or any internet contact is not condoned by Camp Clover Point. We define technology as any electronic device that is capable of communicating through written, verbal, or photographic means. This includes but is not limited to: cell phones, MP3 players, I-Pod s, PDA s, laptop computers, smart watches, etc. I have read and understand the roles, expectations, and technology policy and agree to follow the rules. I agree not to bring any prohibited items to camp. I understand that failure to follow the rules could result in dismissal as a camper. Youth Signature Parent/Guardian Signature 3
CAMP MEDICAL AGREEMENT A nurse will be on staff at each camp. All prescription medications and over-the-counter medications are collected and given by the camp nurse and MUST be in original bottles with labels and dispensing instructions. Any child requiring injections should provide medications, syringes and written instructions signed by physicians. Please send written instructions for any over-the counter medication with the child if the treatment differs from the label. Camp will have certain basic over-the-counter medications. The majority of children seen by the nurse require no more than basic first aid or treatment you provide for your child at home. Common problems the children have are headaches and stomach aches. Listed below are medications that will be stocked in the camp nurse s station: Acetaminophen (i.e. Tylenol) Antihistamine (i.e. Benadryl) Ibuprofen (i.e. Advil) If you wish to have the nurse dispense any of these medications instead of sending these from home, please complete the form below. My child ( ) has permission to take: Decongestant Antacid (i.e. TUMS) Hydrocortisone Polysporin (i.e. Neosporin) Calamine Lotion Sunscreen/Aloe Vera All of the above marked medications None of the above Additionally, please list any medications that will be sent with camper: MEDICAL INFORMATION I certify all information in the Health Form in 4HOnline is current. Youth Signature Parent/Guardian Signature 4
BUS PICK-UP and DROP-OFF CONFIRMATION FORM (TRADITIONAL CAMP ONLY) Please indicate the locations where the counselor will be picked up and dropped off by the bus: Fayette (Fayette HS Parking Lot) Columbia (Cosmos Park, Business Loop 70, Buford Shelter) Ashland (Moser s Grocery Parking Lot) *Please note that we try our best to get the youth loaded as quickly as possible the last morning of camp and our return time may vary. 4-H ACTIVITY ACCEPTANCE FORM Already signed on 4HOnline Educational events and activities are coordinated by the University of Missouri 4-H Youth Development Programs. All participants (adults and youth) must observe the following guidelines for conduct: Participate fully in all sessions Show respect for property and facilities used during the activity and assume financial responsibility for any damage they cause. Observe the established schedule, including being in their own cabin at the announced curfew. Appropriate and courteous behavior is expected. Swearing and obscene gestures are not permitted. All other participants, guests, chaperons and visitors should be treated with respect and common courtesy. Clothing and apparel should be appropriate and modest. No garments with alcohol, tobacco, insensitive or sexually suggestive phrases or artwork permitted. This event should bring about a natural high. No alcohol, tobacco, stimulants or non-prescribed drugs will be allowed. We understand and accept the responsibility for following the above guidelines, and understand that failure to do so may result in dismissal from the event or activity. Further, we accept financial responsibility for damages to property or materials, travel costs, and/or program costs which might result from violation of this agreement. Both as to myself and my heirs and personal representatives, I release all 4-H officials, leaders, or dealers affiliated from any and all liabilities and right of action that may arise from any damage or injury which I may receive while attending or participating in this event. I will be bound by all rules and regulations while participating in said event. CHILD PHOTO AUTHORIZATION Preference has been determined in 4HOnline I authorize the University of Missouri to make pictures and sound recordings of me and use the same in any form for its purposes and consent that the pictures and recordings may be copied, published, telecast or broadcast for such purposes together with descriptions and editorial statements. The University of Missouri is not responsible for third party photographs. 4-H CAMP PROVISION Providing a safe and educational camp experience for youth is the top priority of the 4-H Camping Program. Campers who violate 4-H Camp rules and policies concerning substance possession, appropriate personal conduct or safety will be sent home immediately. In such an event, it is the parent/guardian's responsibility to retrieve their child immediately from Camp Clover Point. Camp fees will not be refunded. The signatures below indicate acceptance of these terms. Youth Signature Parent/Guardian Signature 5
JOB DESCRIPTION FOR LEAD COUNSELOR(S) Job Title: Lead Counselor(s) Duties and Responsibilities Job Purpose: Responsible for the implementation of the camp programs as designated by the Camp Committee. Qualifications: 1. Strong interest in youth camping programs 2. Experience in management or supervision of others; ability to take a strong leadership role 3. Experience in working as part of a team 4. Positive attitude 5. Ability to address problems quickly and effectively 6. Effective communicator 7. Leadership experience (specifically leading peers) Examples of Duties: 1. Serves as a liaison between camp & 4-H staff and fellow counselors 2. Designs and implements evening recreation with help of a team/committee 3. Oversees and carries out each camp group s programming schedule and workshop activities, ensuring a healthy, positive camping environment. Includes set up and tear down of activities 4. Enforce camp rules and regulations; model standards for conduct as they pertain to camp counselors and campers 5. Support and guide the development of camp counselors in each camp group 6. Notify the Extension Staff of the need to purchase any additional camp supplies that are needed beyond the regular ordering of food and camp supplies 7. Make sure light maintenance is done, including trash pickup, cleaning and replenishing common use areas, keep campgrounds neat and clean 8. Help fill in when camp counselors are pulled away from their camp groups for various reasons 9. Float throughout camp during workshops and rotations to assist camp groups with bathroom breaks, water refills, sunscreen application, nurse visits, etc. 10. Responsible for the upbeat morale of the camp counselors 11. Observe camping experience and step in when needed to ensure campers are having a positive experience 12. Help staff with duties as assigned 13. Coordinate counselor party Final authority on decisions in regards to the operations of camp and programs is left solely to the Extension & Camp Staff. If you are interested in being considered for this position, please attach a 1-page typed letter summarizing why you think you should be selected. Please include any ideas that you have to make camp inclusive and welcoming for all. 6
COUNSELOR INTERVIEW TIME SLOTS Please indicate 2-3 interview time slots below. Your interview time will be emailed to you on January 24, 2018. Notification of camp counselor selection will be emailed on February 2, 2018. Desired Interview Time Slots- Wednesday, January 31, 2018. Intervals are slated at 15 minute slots to allow for transitions, actual interview times will approximate at 12 minutes. **Please arrive 10 minutes prior to your interview time in case we re running ahead of schedule** 4:30-4:45 4:50-5:05 5:10-5:25 5:30-5:45 5:50-6:05 6:10-6:25 6:30-6:45 6:50-7:05 7:10-7:25 Interviews will be held in Boone County Extension Office. Please place an X if you wish to be considered for the Lead Counselor position. *Note: Your interview may exceed 15 minutes. Suggestions for 2018 Camp Theme: 7
COUNSELOR INTERVIEW PRACTICE QUESTIONS Your interview time will be emailed to you on January 24, 2018. Interviews will take place on January 31, 2018. Notification of camp counselor selection will be emailed on February 2, 2018. Intervals are slated at 15 minute slots to allow for transitions, actual interview times will approximate at 12 minutes. Interviews will be held in Boone County Extension Office. Please arrive 10 minutes prior to your interview time in case we re running ahead of schedule. Are you a team player? Do you prefer to work alone or with others? How do you handle stressful situations? What do you do when you don't know the answer to a question? What made you want to be a camp counselor? Did you attend camp as a child? What did you like about it? What did you dislike? With what age groups do you like working with? What do you like about working with kids? Explain a time when you had a conflict with a friend, how did you handle it? Give an example of a time that you changed a child s emotions from frustration or sadness to happiness. Tell me about a time when you acted as a leader for a group of people. Tell me about a time when you followed the rules, even though it wasn't the cool thing to do. Name a type of activity you would do with children who were feeling left out. What would you do if one of your campers refused to do an activity with the rest of the group? What would you do if it was raining and you had a group of twenty campers to entertain? How would you handle a child who was misbehaving and not following instructions? Imagine one of your campers is homesick and wants to go home or call a parent. What would you do? 8