4-H Camp Chaperone Application
Crawford, Richland, Monroe, La Crosse and Vernon Counties

Requirements:
Aged 21 years or older
Complete the 4-H Volunteer Certification process (Chaperone Role Description, Health Coordinator Role)

Pre-Camp Zoom for Campers, Counselors and Chaperones - July 9, 2025
Pre-Camp Zoom for Counselors & Chaperones - July 28, 2025
Camp Dates: July 30-August 1, 2025 Upham Woods, WI Dells 

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Email *
Full Name *
Address (City and Zip) *
Phone *
Cell Phone *
Email *
County *
T-Shirt Size *
Are you currently a certified 4-H volunteer? *
Do you have a child who will be attending 4-H Summer Camp? *
What age group do you prefer to work with during camp? (select all that apply) *
Required
Describe any past camp and/or chaperoning experience.  *
What interests you about chaperoning? What are your expectations? *
All adult volunteers are primarily chaperones, but please indicate below if there are any additional roles you would like to assist with during 4-H Summer Camp. 
Volunteers are essential to a successful camp! We want to match your interests & talents with the programs being offered at camp.  Please let us know what you would like to assist with at camp. (check all that apply)
What to Expect as a 4-H Camp Chaperone
  • Your role is to support the efforts of youth camp counselors. You will not be in a lead role, but rather, as a supporting cast member, you will work behind the scenes to help everything go smoothly. You will be assigned to accompany and reside with a cabin group with 10-15 kids and 2-3 counselors.
     
  • Time Commitment: 4-H Summer Camp is a three day program. We anticipate you'll want to engage in most camp activities, however you will also have some down time. 

  • Transportation: Some counties may require your assistance to fulfill ratio on the bus to and from camp. If you prefer to drive your own vehicle, please contact your 4-H Educator. 

  • Your Camp Registration Fee is covered, as is one 4-H camper fee for your child.

  • Housing: Chaperones stay in the cabins with their group of counselors and youth. This may or may not include your child(ren). 

  • Meals and snacks are provided - including coffee! 

  • Remember that you are a role model for both the counselors and the campers and that FUN is included!
Expectation Agreement for Area 13 4-H Summer Camp
If selected as an Adult Camp Chaperone I understand and agree that:
  • My role at camp is to provide a positive, nurturing, fun environment for campers and counselors
  • I will treat other staff, counselors, and campers with dignity and respect
  • I will not allow or participate in any kinds of initiation activities (skits, pranks, jokes) during camp.
  • I will attend all meals, campfires, and evening programs unless assigned other duties by the Camp Directors. 
  • I understand that the use and possession at camp of any alcohol, tobacco, or other drugs is cause for instant dismissal. 
  • I understand that verbal, sexual or physical abuse towards other people; including staff, counselors or campers is instant dismissal. 
  • I will only use my cell phone for personal use when away from campers and counselors (using it to take appropriate pictures of activities or camp use is permissible). 
  • I will remain at Upham Woods during the camp sessions, unless approved by a Camp Director. 
  • I will follow all rules and regulations set forth by Upham Woods Outdoor Learning Center. 
I understand that if I break any of these expectations listed above that my actions could results in my early departure from camp, removal as a leader in the Wisconsin 4-H program, additional county action. 
Please type your name below to show agreement with the statements above.  *
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An EEO/AA employer, University of Wisconsin-Extension provides equal opportunities in employment and programming, including Title VI, Title IX, and the Americans with Disabilities Act (ADA) requirements.  
A copy of your responses will be emailed to the address you provided.
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