Howard County 4-H Camp
Adult Volunteer Staff Application Form
DUE BY DECEMBER 19th TO:Howard County 4-H Office
3300 N. Ridge Rd, Suite 240
Ellicott City, MD 21043
University of Maryland Extension is collecting information in order for you to participate as a 4-H Residential Camp Adult Staff person. If you do not provide the requested information, you may not be able to receive additional program materials. The information you provide may be shared with UME and short-term appointed volunteers or instructors. Information provided to UME may also be shared among offices within the University System of MD and outside entities as necessary or appropriate in the conduct of legitimate University business and consistent with applicable law. Because the University is a state educational institution, such information may also be subject to disclosure under the MD Access to Public Records Act. Individuals may inspect and /or correct their personal information as provided by the “Public Records Act” and/ or other applicable.
Name: ______Email: ______
Address: ______
Home Phone: ______Cell Phone:______
In order to be considered for a Camp Adult staff position you need to be 21 or older as of Jan 1, 2015.
What experience do you have working with youth?
Check those experiences you have had working with youth:
Babysitting (Age group: )
Teacher (Grade: and Subject )
Coach (what: )
Day Care Provider (License Number: and County )
Youth Group Volunteer other than 4-H ( Organization)
Other (Explain: )
Have you attended Howard County 4-H Camp as a camper or teen leader? Yes No
Camp Leadership – List your previous experience in a camp leadership position. What organization and how long were you involved?
Recreation- List sports, games, or recreational activities you are skilled at teaching with youth, leaders and campers.
Activities -List any hobbies or special skills you may have that would assist you in your staff position at camp? Do you hold a certification or licenses in any activities?
Solve this problem:
It’s free time, you are in the Recreational Hall with some campers, when a camper comes to you and informs you they think they have a rattle snake outside of their cabin. What should you do?
Solve this problem:
You are running an activity and you have a camper that refuses to participate in the activity and continues to be distracting to the entire group. What should you do?
What other skills you can offer our 4-H Camping program:
Are you Red Cross First Aid Certified?Exp. Date:
Are you Red Cross CPR Certified?Exp. Date:
Are you Red Cross Life Guard CertifiedExp.Date?
How will you encourage teamwork, spirit, and cooperation among youth and staff members?
Why should you be selected as an adult staff volunteer member of the Howard County 4-H Resident Camp?
In your opinion, why is camping an important delivery method for youth development?
In completing and submitting this application, I understand that there is an obligation to attend and participate in planned camp staff trainings and become a UME appointed volunteer.
Signature: Date:
The University of Maryland Extension programs are open to any person and will not discriminate against anyone because of race, age, sex, color, sexual orientation, physical or mental disability, religion, ancestry, national origin, marital status, genetic information, political affiliation, and gender identity or expression.