2025 Glenn County 4-H Camp - Teen Camp Counselor and Youth Director Application

First Name  ✻

Last Name ✻

Phone Number ✻

Cell Phone Number ✻

Email (can't be a school account) ✻

Street Address ✻

City ✻

State ✻

Zip Code ✻

County ✻

Gender ✻

Are you currently enrolled in 4-H? ✻

Age as of December 31, 2024 ✻

Grade entering in August 2025 ✻

In case of an emergency, please contact (Insert Name): ✻

Relationship ✻

Phone Number

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T-Shirt Size for Camp ✻

CPR Certified: Are you currently certified? Being certified in 1st Aid and CPR is not a requirement for applying to be a camp counselor. (Mark all that apply) ✻

Have you attended Glenn County 4-H Camp as a camper in previous years? ✻

If you answered yes, how many years have you previously attended as a camper?

Have you attended Glenn County 4-H Camp as a Teen Camp Counselor in previous years? ✻

Tell us about your previous experiences working with children (i.e., babysitting, church, Jr. Leader, Kiwanis, other). What did you like and dislike about working with the kids? ✻

What experience do you have as a leader? What leadership roles have you held in the past (include both inside 4-H and outside 4-H Leadership roles)? ✻

What skills do you want to learn/grow from your role and experience as a 4-H Teen Camp Counselor or Youth Director? ✻

Are there any concerns you may have or have something that would be good for us to be aware of? ✻

Reference 1 First Name, Last Name ✻

Reference 1 Phone Number ✻

Reference 1 Relationship

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Reference 2 First Name, Last Name

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Reference 2 Phone Number

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Reference 2 Relationship

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Reference 3 First Name, Last Name

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Reference 3 Phone Number

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Reference 3 Relationship

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Will you be able to stay for the duration of camp? (Wednesday, June 18 - Sunday, June 22, 2025) ✻

Teen Camp Counselor and Youth Director commitment statement: If chosen as a Teen Camp Counselor or Youth Director, I will commit to understanding the requirements and responsibilities of a good Teen Camp Counselor or Youth Director. I will commit to completing all the training and being at 4-H Camp each day for my duties as assigned. I understand that being a Teen Camp Counselor or Youth Director is a huge responsibility, and I will be attending camp, as a role model for campers. I am willing and able to give of myself to help them grow and develop and enjoy 4-H camp. I submit that all information on this application is true and complete. I have read and understand the role and description of a Youth Director and will abide by the practices set forth by the Glenn County 4-H Camp Committee. I understand that if I do not meet the standards of a responsible Teen Camp Counselor or Youth Director, I will be dismissed from my duties. This role and description are not intended to be all-inclusive.

By placing my initials in the box provided, I'm committed to participating in the 4-H Camp planning process. I will attend a minimum of six of the scheduled planning meetings. If I can't make a meeting or need to make arrangements, I will notify our 4-H Camp Director, Maddie Coleman, and make arrangements. I understand there may be a planning meeting on a weekend, and our Camp Director will work with us to find a time that works best.

If you agree to the above terms, please place your initials in the space provided.  ✻

By placing my initials in the box provided, I agree to upload or turn in the Health History Form, Glenn County 4-H Camp Teen Counselor Camp Rules 2025, and one Letter of Recommendation by the Camp Application deadline of Monday, March 31, 2025. To turn these forms in electronically, the "upload" option is at the bottom of the survey. The link to the Health History and Authorization form and Camp Rules 2025 is accessible at the bottom of the survey. These forms can be dropped off at the UCCE Office located at 821 E. South St., Orland, or can be emailed to glenncounty4h@ucanr.edu, by the deadline.   ✻

As the parent/guardian of the youth completing this application, I understand the necessity to only select individuals who are committed to the 4-H camping program. I will, to the best of my ability, support and encourage my teens to uphold their commitment to the Glenn County 4-H Camp Committee. I understand that if my teen does not meet the standards of a responsible Youth Director, they will be dismissed from their duties. If you agree to the terms listed above, please place your initials in the space provided.  ✻

Name (First name and last name) ✻

Phone Number ✻

Name (First name and last name)

 Phone Number

Name (First name and last name)

Phone Number

Are there any special accommodations needed?  ✻

Please indicate why you want to hold the position as a Youth Director at Camp this year. Describe what skills and abilities a Youth Director Should obtain.

Teen Camp Counselor and Youth Director Registration Fee is $50.00. Camp Fees can be paid by cash or check at the UCCE Office located at 821 E. South Street, in Orland.  ✻