June 16 – 22, 2024
Camp Sweetwater
in Mariposa, California
If appointed, adult fee is $210/adult.
Please check with your local 4-H office about fee assistance.
Please use this application to indicate your interest in participating
as an adult chaperone for the 2024 4-H Summer Camp.
Applications must be submitted by May 15, 2024 and will be notified by May 20, 2024
Last Name: ✻
First Name: ✻
Cell Phone number:
Please use format 000-000-0000 ✻
E-mail address: ✻
4-H County: ✻
Were you at least 25 years old on December 31, 2023?
Overnight chaperones are required to be 25 years or older. ✻
What is your T-shirt size? ✻
Do you have any dietary preferences or food allergies that you would like the camp kitchen to know about? ✻
Do you have any physical or medical needs you would like to share with the camp health officer? ✻
Which adult chaperone roles are you interested in for camp 2024?
Check as many as apply. ✻
Please describe any other overnight chaperone or youth leadership experiences you have had for 4-H or other youth programs/organizations.
For example: Leadership Overnight Chaperone, State Leadership Overnight Chaperone
Enter "N/A" if None. ✻
What if any are your current adult leadership roles in the 4-H program? (e.g. project leader, club leader, event coordinator, etc.). If applicable, list leadership roles in other organizations. Please list all roles you currently hold. ✻
Do you have a current CPR/First aid certification? (this may be attained once you are appointed to the position) ✻
Have you ever taken a Food Handler Course and Assessment? ✻
Have you ever attended the California State 4-H Camping Conference? ✻
Describe your experience in teaching and working in partnership with youth ages 9-18. ✻
What strategies will you use to create a welcoming camp for diverse youth and adult volunteers? ✻
ANR NONDISCRIMINATION AND AFFIRMATIVE ACTION POLICY STATEMENT FOR UNIVERSITY OF CALIFORNIA
It is the policy of the University of California (UC) and the UC Division of Agriculture & Natural Resources not to engage in discrimination against or harassment of any person in any of its programs or activities (Complete nondiscrimination policy statement can be found at http://ucanr.edu/sites/anrstaff/files/215244.pdf)Inquiries regarding ANR’s nondiscrimination policies may be directed to UCANR, Affirmative Action Compliance & Title IX Officer, University of California, Agriculture and Natural Resources, 2801 Second Street, Davis, CA 95618, (530) 750-1343.
If appointed as an adult chaperone, registration fee is $210. A link will be emailed to you after chaperone selection to submit the fee.
For verification that you are human, please enter the following code in the box below: QMCDQT
(if the code is not entered correctly, the survey will not be submitted)
