January To: 4-H Members From: 4-H Counselor Committee, Camp Crowder 4-H Camp Dale Hunsburger, Shaun Murphy, Janet Sager and Rick Smith

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1 Clinton County P.O. Box South Main Plattsburg, MO PHONE (816) FAX (816) WEB SITE January 2013 To: 4-H Members From: 4-H Counselor Committee, Camp Crowder 4-H Camp Dale Hunsburger, Shaun Murphy, Janet Sager and Rick Smith Camp has one key ingredient that we cannot do without and that missing key ingredient is YOU!! It is again time for 4-H members to apply for Camp Counselor positions at the 2013Camp Crowder 4-H Camp. Counselor Selection will be a similar process to last year. We have a limited number of Counselor positions for camp this year. Many factors go into counselor selection including leadership skills, meeting specific camp needs and the ability to be part of an awesome team. Counselors will be selected through a process that involves three equally weighted components: Written application Local 4-H staff recommendation Interactions at the Counselor Selection Workshop It is important to note that ALL counselor applicants will be expected to attend ONE Counselor Selection Workshop. Please rank your choices on the application. Only two workshops dates will be offered, April 6th and April 20 th. If you are unable to attend one of the Counselor Selection Workshops, we hope that you will be able to submit your application next year. At Counselor Selection, we see this as an opportunity for regional youth to develop leadership skills while coming together as a team for a great time (lunch will be provided). Youth will experience a wide array of teambuilding activities, leadership training, a service learning project and fun! Youth will design a mock 4-H Camp session with other youth be thinking! This is your chance to show us what you can offer the 2013Camp Crowder 4-H Camp. Any teen, who is a member in good standing, between the age of 14 and 18 (as of 1/1/13) can apply to work as a Camp Counselor. Applications will be due March 1 st and no late applications will be accepted. You will be notified as to which of the training workshops you will be attending. Counselor positions will be announced in late April. When you apply, make sure to include the following: Completed application Completed MO 4-H Health Form (online at 4h.missouri.edu/resources/materials/docs/Y640FILL.pdf) Signed Code of Conduct (included in packet) If you have any questions, please don t hesitate to contact Dale, Shaun, Janet, Rick or your local 4-H Youth Staff. See you soon!

2 Camp Crowder 4-H Camp Counselor Code of Conduct The University of Missouri 4-H Youth Development Programs coordinates 4-H educational events and activities, such as 4-H Camp. All participants (adult and youth) must observe the following guidelines for conduct: 1. I will participate fully in all sessions. If I cannot attend a planning session for valid reasons, I will directly notify the camp director or my Youth Specialist (not another counselor). 2. I understand that I am a reflection of 4-H, my county, and the Youth Staff. I will work hard to honor that image by being on time to events, mentoring youth, and leading by example. 3. I will work with the Extension Service staff to develop and conduct a quality program for the 4-H campers. 4. I will show respect for property and facilities used during the camp and planning sessions, and assume financial responsibility for any damage I cause. 5. I will observe the established schedule, including being in my own cabin at the announced curfew. 6. I will use appropriate and courteous behavior. I will not swear or use obscene gestures. All participants, guests, chaperons, and visitors will be treated with respect and common courtesy. 7. This event should bring about a natural high. I will not use alcohol, stimulants, or nonprescription drugs. 8. I will help develop, and observe all basic camp rules and agreements, including: a. No tobacco. b. No fireworks, matches or lighters. c. No boys in the girl s cabins and vice versa. d. Observe camp boundaries. 9. I will serve as a positive role model. By my example, I will help individuals learn to respect and cooperate with others. I will teach others to participate with honesty and fair play. 10. I will work as a team player for the good of all people. I will work cooperatively with other staff for the good of all involved. 11. I will provide a safe environment. I will not harm youth or adults in anyway, whether through harassment, physical force, verbal or mental abuse, neglect or other harmful experiences. I understand and accept the responsibility for following the above guidelines, and understand that failure to do so could result in dismissal from 4-H Camp and my role as Camp Counselor. Further, I accept financial responsibility for damages to property or materials, travel costs and/or program costs which might result from violation of this agreement. Counselor Signature Date Parent/Guardian s Signature Date

3 Camp Crowder 4-H Counselor Application Due March 1st Who is Qualified: Must be age as of 1/1/13; responsible, positive role model, member in good standing, exhibit positive interaction with youth, attend mandatory Counselor Selection Workshop. Application Directions: Application must be completed with necessary attachments and signatures and postmarked March 1, Mail to: University of Missouri Extension, 101 S. Main Street, Plattsburg, MO or to: or fax to: (call first). No late applications accepted. Applicants will be selected on qualifications and need. Please rank your choice of available Counselor Selection Workshop Dates, 1 or 2. Candidates MUST ATTEND ONE Workshop. Workshops will be held tentatively at Camp Crowder, Trenton. Select your preference below: Applicant Information: Saturday, April 6 10 am to 2 pm Saturday, April am to 2 pm Name 4-H County Address City Zip Male Female Home Phone ( ) Age (as of 1/1/2013) Birth date m/d/y Address Cell phone number # Years in 4-H # Yrs Previous Camper # Yrs Previous Counselor Choice of Camp Date: June 3-6 June Are you flexible and able to participate either week? Yes No T-Shirt Adult Size S M L XL XXL Parent /Guardian Information: No date preference flexible for either date Name Address Home Phone ( ) Work Phone ( ) Cell Phone ( ) I understand and agree to the expectations for myself/my child, including the code of conduct. Parent 4-H member Signature Signature Verification of Member in Good Standing and recommendation to be a counselor Signature 4-H Club Leader Date Please don t forget to answer all of the questions on the back of this page. This application, including the questions, will be evaluated and used in the selection process. University of Missouri, Lincoln University, U.S. Department of Agriculture and Local Extension Councils Cooperating equal opportunity/ada institution

4 Short answer: Answer the following questions in your own handwriting, use only this page. 1) Why are you interested in serving as 4-H Camp Counselor? (30 words or less please) 2) List 3 areas or skill sets that you would you like to learn more about that could help you in your Counselor role and why? 3) List 3 special skills, abilities or interests that you have that would be useful as a Counselor and explain how they would help you. 4) In your opinion, what is the most important skill or ability a camp counselor must have? List one skill and please be specific. Why? 5) Think back over all your years as a camper or counselor. Tell us about one example where a counselor showed true leadership. Tell us what they did and how it showed true leadership. If you have never been a camper or counselor please use another example from your life to illustrate this point.

5 Missouri 4-H University of Missouri 4-H Center for Youth Development Youth Health Statement, Parent Consent & Event Acceptance Form Complete the ENTIRE two page form Do NOT alter the form in any manner For health or safety reasons, every person attending the event must submit a completed health form prior to the beginning of the program. Event Date(s) of Event Name of Youth County Gender Female Male Parent(s)/Guardian(s) Birth Date Age Address City State Zip Home Phone Work Phone Cell Phone Do you have health insurance? yes no Insurance Company Name Insurance Company Policy Number Insurance Company Address City State Zip Insurance Company Phone Will your child be bringing any type of medication to this event? yes no If yes, explain. Does your child have any allergies? yes no If yes, explain. Describe any special needs (medical, physical or mental challenges) we should be aware of. Does your child have any special dietary needs? yes no If yes, explain. Date of last Tetanus immunization If necessary, I approve of officials taking my child,, to the nearest doctor or hospital. I further understand that, should a health problem arise, I will be notified. If I cannot be reached by phone, such medical treatment, including surgery, as deemed necessary by competent medical personnel, would be rendered. Name Emergency Contact Information Relationship Home Phone Work Phone Cell Phone Family Physician Office Phone Home Phone Y640 Page 1 of 2 Rev 6/12

6 Event Acceptance Education events and activities are coordinated by the University of Missouri 4-H Youth Development Programs. All participants must observe the following guidelines for conduct: Participate fully in all sessions. Show respect for property/facilities used during the event and assume financial responsibility for any damages caused. Follow the established agenda and expectations for behavior. Use appropriate language and wear acceptable clothing at 4-H activities and events. Use no alcohol, stimulants, non-prescription drugs or tobacco products. I understand and accept the responsibility for following the above guidelines and understand that failure to do so will result in dismissal from the event or activity. Further, I accept financial responsibility for damages to property or materials, travel costs and/or program costs that might result from violation of this agreement. I understand and agree that in consideration of the acceptance in these activities, we release 4-H, the Curators of the University of Missouri, their respective officers, agents and/or employees from all liability and loss (including court costs and attorney fees) resulting from any property damage, personal injury and bodily injury including death to me in the course of these events. We will be bound by all rules and regulations while participating in said events. CHILD PHOTO AUTHORIZATION: I authorize the University of Missouri to make pictures and sound recordings of my child/children 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. Date Date Signature of Parent/Guardian Signature of Youth Both youth and parent (guardian) must sign this form. If you choose to have this form notarized, your signature must be witnessed by the Notary Public. I understand if I do not have this health statement and consent form notarized, it could cause a delay in my treatment. Notary Optional (some hospitals require) State of Missouri, county of My commission expires Subscribed and sworn to before me on this day of, 20 Notary Public Signature 4-HMU is an Equal Opportunity Institution. For concerns about access or opportunity, contact your local MU Extension center or call The University of Missouri complies with the guidelines set forth in the Americans with Disabilities Act of If you have special needs as addressed by the Americans with Disabilities Act and need assistance with this or any portion of the enrollment process, call Reasonable efforts will be made to accommodate your special needs. Copy Form as Needed Y640 Page 2 of 2 Rev 6/12 MJW