Application For 4-H Camp
Adult Advisor / Chaperone

 Adult leaders age 25 and older as required by California 4-H for county overnight events.

BLT _____ Winter Camp _____ Summer Camp _____ SLC_____ Cal Focus_____ Washington Focus_____

 

Full name:

Birth Date (mm/yyyy):

Street Address:

City/State/Zip:

E-Mail Address:

Current 4-H Leader:

 Yes No (Circle One)

Gender:

 Male Female (Circle One)

4-H Club Affiliation:

Years in 4-H:

Will you be able to Attend for the entire time?

 Yes No (Circle One)

Will your own children be attending ?

 Yes No (Circle One)

Have you ever attended an OC 4-H Overnight Event before?

 Yes No (Circle One)

Do you have other camp leadership experiences?  (please describe, use back if necessary)
I have read the Position Description for 4-H Camp Adult Advisor/Chaperone and agree that I will be able to perform these duties.
___________________________________________
Signature		 __________
Date

Please mail application and have 2 References mail Recommendation Forms directly to:

Rachel Taylor
Orange County 4-H Council
1045 Arlington Drive,
Costa Mesa, CA  92626