4-H Camp Counselor Application
Application and $30.00 camp fee due not later
than Friday, June 15th, 2007
to the USU Extension Office or Lareta Reynolds
Name:_____________________________________________________ P.O. Box:________________
Town:_____________________________________________________ Zip Code:________________
Phone Number:_________________________________________ Grade you just left:______________
Equipment that I can provide for camp:(tents, etc.) ___________________________________________
My parents will be able to help with:
_____Transportation to camp _____Chaperone at camp
_____Transportation from camp _____Other (please describe)
I have participated in the following 4-H service projects within the last two months:
Please Note: All Camp counselors must have participated in an approved service projects between Jan 1st
and June 15th in order to qualify to be a camp counselor. A camp counselor training is also mandatory to
be considered as a camp counselor!
Includes all meals, a shirt, camp materials, crafts, workshop materials, and campground fees.
Please read the following carefully:
I understand that 4-H Camp will be conducted June 26th-28th at Tushar Lakeside Campground. I
understand that there will be camp counselor workshops held prior to camp. I understand that I must
attend one of the workshops in order to be eligible to be a camp counselor. I also understand that if I am
not registered for camp prior to camp, I will not be allowed to attend or visit 4-H camp.
4-Her’s Signature Date
I, also, understand and agree:
Parent’s Signature Date