Po-Croix-Bar 4-H Camp
Camp Counselor Application
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Name
Address (street, city, state, zip)
4-H Club
County
e-Mail
Cell Phone Number (Contact Number)
Current Age
Grade
Clear selection
Gender
Clear selection
Years in 4-H
T-shirt Size
Clear selection
Have you previously attended a Camp Counselor Training Workshop? If so, when
Do you want to be considered for a junior directors position?
Clear selection
If you want to be considered for a junior directors position, what skills do you have that would make you successful in this position?
List camps and year attended (4-H and non 4-H) which you have attended as a CAMPER.
List camps and year attended (4-H and non 4-H) which you have attended as a COUNSELOR.
Please hold the following dates for your participation as a camp counselor.  (check all that apply)
Camp Activities: Which of the following are you comfortable leading at camp?  Check all that apply. *
Required
Choose 5 camp activities from above and describe your experiences with them.
Explain why you want to be a camp counselor.
What do you want to learn from your experiences as a camp counselor?
If you have any dietary or other needs, please describe
Signature (typing your name counts as your signature) Please note: An EEO/AA employer, University of Wisconsin-Madison Division of Extension provides equal opportunities in employment and programming, including Title VI, Title IX, the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act requirements. *
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