4-H Adventure Camp Counselor
Application Close Date is December 10th, 2018
Email address *
Name *
Photo (portrait style of you only please) *
Required
Phone Number *
Street Address *
City *
State *
Zip Code *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
Demographics (Community) *
Parent Name *
Parent Phone Number *
Parent Email *
Grade in School *
Years in 4-H *
Years Completed as Counselor (include completed CIT year) *
Certifications
Certification Copies
References (3 required only if 1st year counselor) Include name, phone number and relationship, email (Required)
Enrolled in 4-H *
Bus Location *
T-Shirt Size (adult sizes) *
Training Attendance (Check all that you can and plan to attend.) *
Required
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