Camp - Camp Counselor Application

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					   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!

Cost: $30.00
      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

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