YOUTH CAMP COUNSELOR APPLICATION
Camp Na-Bor-Lee on Lake Roosevelt
July 12th, 9:00 a.m. - July 15th, 12:00 noon, 2017
Counselor & Counselor In Training (C.I.T.) Applicants:
● not limited to 4-H members● Age 13 or older as of October 1, 2016
● must attend designated training and planning sessions
APPLICATIONS ARE DUE: May 1, 2017
To: Marci Dayton 412 S King St Airway Heights, WA 99001 or email
OK to attach extra page if you need more room to answer questions.
1.Name ______County ______
2.Address ______City ______St_____ Zip ______
Email address______
Home Phone ______Cell Phone ______Texting? Yes☐ No☐
3.Grade ____ Age ____ Birthdate ___/__/___ Gender(F) ☐ (M)☐
(Grade & Age as of October 1, 2016)
4.Parent/Guardianname(s) ______
5. Why do you want to be a camp counselor or C.I.T.?
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6.Outdoor Camping experience(s): [Family, Church, Youth Organizations, etc.– include the year-date(s)]
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7.Counselor experience or other experience working with youth (if any):
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9. Special training, interests, education, skills, certifications (if any):
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10. In your opinion, what is the role of a counselor?
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11. Describe the type of role model you feel a counselor should provide for campers:
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12. Describe how you would deal with a child who was having trouble fitting into a group. What would
you do to help him or her feel more comfortable? ______
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13. What do you hope to learn from being a camp counselor? ______
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14.How should you relate to other counselors and adult staff during camp? ______
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15.Why should you be selected to be a camp counselor? ______
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16.Swimming Ability: non-swimmer ☐ beginner ☐ intermediate ☐ advanced ☐
If accepted – Can you bring a tent? No ☐ Yes ☐ What size? ______
T-shirt size (Adult): Small ☐ Medium ☐ Large☐
17.List 3 adult references other than parents/guardians/relatives; can include teacher, leader, agent; Include e-mail addresses and phone numbers.(Attach extra page if you need more room.)
1.______
2.______
3.______
I would like to be a counselor and I have discussed this Leadership Development opportunity with my parent(s). I authorize the contact of listed references and understand a criminal background check will be completed if I am 16 years old or older prior to final consideration of my application. If selected, I will expect to work as a team with other counselors and staff. I understand that I'm expected to attend Counselor Training and the entire Camp session. I would be willing to assume the responsibilities of Counselor and follow the directives of the Director(s) and follow all camp rules.
Signed ______Date ______
Parent's Signature______Date______
RETURN THE COMPLETE APPLICATION BYMay 1, 2017.
If accepted,a $50 camping fee will be payable as of required counselor training date. Send application and direct questions to: Marci Dayton, Camp Director
412 S King St
Airway Heights, WA 99001
Phone/text: 509-994-7607
Email: