Oregon 4-H Cenler- Camp Whit€ OakA 4-H Outdoor Advcnture Program

Yolunteer Camp Counselor Training Information

Thank you for your iuterest in being a counselor at Spring Break Caatp White Oakl We are inviting teensin grades 10-12 to apply to ihe program. The camp dates me March 23- 26,2020. The camp site is theOregon 4-H Center in Salern. We are currently working to coordinate transportation for staffandcamp€rs from Jackson County to Linn County up the I-5 corridor, with several stops as needed. Teens

from other counties will need to provide their own transportation to and from camp. Check with yourccunty 4-H educator about opporrunities for carpooling.

Counselor training will be provided using seven e-learning modules and five Zoommeetings. Eache-learning module is approximately 15 minutes long. Applicants should plan to complete all the modulesand attend all the Zoommeetings. As a counselor hainee, if you have firlly participated in the trainingsyou will be considered over those who have not in the final selection process. Traiaing will be providedin Child Protection, Leadership, Team Building, Communication Styles, Camper Needs, GroupManagement, and Emotional Intelligence. A Teen Counselor Job Description is provided in this packet.

All counselor trainees should plan to attend the four rainings listed below. The Zoom training meetings

will be held from 6:30-8:00 PM on Tuesdays.

Januuy 2l- Introductions. Child Protection, Brain Theory.

February4- Non-verbalCommrmication,SupervisionsTechniques

February 18- Phrases to Live by at Camp, Understanding EI

March 3- Camper Constitutions, How Children Develop

After the Ivlarch 3 session counselor trainees will be notified if they have beea selected to sorve at cantp.

Those selected to be counselors mugt attend &is orientation Zoom meeting:

Thursday, March 19, 6:30- 8:30 PM- Orientation for those selected to serve at camp.

The documents required to apply to serve as a counselor tlre:

'/ The application form,/ 4-H Code of Conduct,/ 4-H Health Form,/ OSU Acknowledgement of Risk and Waiver of Liability Form./ A 250- 500 word typed essay. Tell us why you want to volunteer at4-H Canp White

Oak. What do you hope to gain from the experience?,/ A recommendation letter frorn your 4-H Agent, Carnp Director, teacher or religious

leader. This should be scanned and emailed with the subject line "Camp White OakCounselor Refsrence" to Virginia.bourdeau@oregonst .

The apptication deadline is January 3'd,2020. Mail the first flve documents listed above to Oregon 4-HCenter/ Carnp White Oak Counselors, 5390 4-H Rd., NW, Salem, OR 97304. Applicants willbe notifiedif they have been accepted into the training program by January 10th.

If you have questions or concerns please email Darin Borgstadter at darin.bqrqstadter@oregqnstate.edu

4-H Youth Development, Oregon State University, 106 Ballard Hall, Corvallis, Oregon 97331-3608 T 541-737-4444t

https://extension.oreqonstate.edu/4hlcamp-counselor-trainino 4-H Camp Counselor Training. Agricuhure, Family and Community

Development, 4-H Youth, Foresky, and Extension Sea Grant programs. Oregon State University, United States Department of

Agriculture, and Oregon counties cooperating. The Exension Service offers its programs anci materials equally to all people.

Oregon 4-H Cenler- Camp White OakA 4-H Outdoor {dventurc Program

Volunteer Camp Counselor Job Ilescription

Purpose of the Position: To serve as a youth leader for camper age youth in assigned activity groups orcabins, and to assist adult camp staffin implementing a safe prograrn in an enriching learningenvironment.

Responsible to:Counselor Director: Darin BorgstadterCarrp Director: Lena Hosking4-H Agents and Education on staff

Goals for the Camp Program are to:L4aintain excellent health and safety standardsProvide a well-organized camp pro$amProvide campers the opportunity to grow and learn new thingsMeet State 4-H Camping Benchmarks

Required Applicant Qualifi cation s:

'/ Applicants must be youth in grades i0 - 12,/ C.omplete required application forms by the application deadline.r' Submit a250- 500 word typed essay by the application deadline.'/ Submit a rocoilrmendation letter fi'om your 4-H Agent, Carnp Director, teacher or religious leadsr

by the application deadline.{ Be committed to completing the seven required online e-learning modules.'/ Be available to attend, and fully participate in, five Zoomhaining meetings specified on &e

information form.{ Be available to attend all days of the Camp White Oak program in March at the Oregon 4-H

Center in Salem.r' Willingness to develop leadership, patience, dependability and to display a positive attitude.

Always put the camper's positive experience above your own "wants;" camp is for the camper.Understand the camp schedule, always be on time with your group and support camp policies-even if you do not agree with them.

{ Serve as a positive role model, maintain a positive attitude and avoid undermining othercounselors or staff.

'/ Supervise and coach campers in cabins, dining hall, classes, recreation, camp fre and other campbased situations

'/ Assure that bullying and other negative behavior are not ignored in camper group. Understandhow to engage adult help as needed.

'/ Supervise campers in cabins overnighq along with one or more Teen Carnp Counselors and/oradult staff.

'/ Observe campers for signs of skess or illness and report to camp health officer as needed.'/ Work cooperatively with other teen counselors, avoiding special attachments during the camp

period.

4-H Youth Development, Oregon State University, 106 Ballard Hall,.Corvallis, Oregon 97331-3608 T 541-7jT4444 |

https:l/extension.oregonstate.edul4h/camp-counselor-traininq 4-H Camp Counselor Training. Agriculture, Family and CommunityDevelopment, 4-H Youth, Foresfy, and Extension Sea Grant programs. Oregon State University, United States Department ofAgrieulture, and Oregon counties cooperating. The Extension Service offers its programs and materials equally to all people.

Duties:

&" oregon 4-H center- camp trthite oakA 4-H Oqtdoor Adventsrc Program

Volunteer Camp Counselor Application

The application deadline is January 3"dr 2020. Mail the five required documents, listed on theinformation letter, to Oregon 4-H Centerl Camp White Oak Counselors, 5390 4-HRd., NW,Salem, OR 97304. Applicants will be notified if they have been accepted into the trainingprogram by January 10e.

Applicant Name County:

Applicant Identifi es as.

Address:

Female. Non binarylother:Male:

Email: Cell Phone Number.

School Attending: Current Grade:

ParentlGuardian Name:

Parent Email:

Cell Phone Number:

Does the Applicant have previous expe

Does the Applicant have previous expe

rience as a camper? Yes No

rience as a camp counselor? Yes No

If yes where have you been a counselor?

Does the Applicant have other experience supervising ileading younger youth? Yes No

If yes, what is your experience?

By siguing below the Applicant and Parent certi$r that they have reviewed the Camp White Oak

Camp Counselor job description pnd that the applicant will complete the online eJearningmodules, attend the Zoom training sessions and attend all days of the Camp White Oak program

in March at the Oregon 4-H Center in Salem.

Applicant Signature: Date:

Parentl Guardian Signature: Date:

4-H Youth Development, Oregon State University, 106 Ballard Hall,-Corvallis, Oregon 97331-3608 1 541-737-4444 |

httpsJ/extension.oreqonstate.edu/4h/camp-counselor-traininq 4-H Camp Counselor Training. Agriculture, Family and Community

Development, 4-H Youth, Foresfy, and Extension Sea Grant programs. Oregon State University, United States Department ol

Agricuhure, and Oregon counties cooperating. The Extension Service offers its programs and materials equally to all people.

OREGON 4-H YOUTH DEVELOPMENT PROGRAMYOUTH CADE AF CONDUCT

The well-being of all 4-H program participants is important. Everyone has responsibilities.

When I participate in tt-H programs, t agree to . . .

1. Engage fully with a positive attitude and creative energy.

2. Be courteous to others, even if they're different from me.

3. Be cooperative. Encourage individuals. Help others. Support teamwork.

4. Be willing to ask an adult for guidance to make good decisions and take appropriate aclions.

5. Use language that is respectfulto others. {Swearing, harassment, and bullying are not allowed.)

6. Take care of the property I interact with, and assume responsibility for purposeful damage I maycause.

7. Wear appropriate clothing for program activity(s). Follow the specific dress code, if provided.

8. Be present and on time for all parts of the program. (l will notify the appropriate supervisor if I

have a health or schedule problem.)

9. Use technology (cell phones, computers, tablets, mp3 players, game devices, etc.) during freetime, or in ways that contribute to the goals of the program.

10. Treat animals humanely and provide them appropriate care.

11. Not engage in Personal Displays of Affection (PDA). (lt is distracting and inappropriate.)

12. Know and follow federal, state and local laws that apply to my age (e.9., tobacco, alcohol, illicitdrugs, fireworks).

13. Know and follow safety policies of the Oregon State University, Extension Service, and guidelinesof the 4-H Youth Development Program. (Such as: not leave the program area withoutpermission from the program supervisor, be in assigned lodging and not trade rooms duringovernight activities; abide by curfew hgurs; remain in gender specific areas [no boy in a girl's room/ no girl in a boy's room]; handle firearms only in secured, designated areas under the directsupervision of a trained 4-H Shooting Sports volunteer; and, any other additional safety policiesestablished by a specific event or program.)

I have read and agree to the Code of Conduct above. I understand that it I violate any part of thisagreement, I may be senf home from a 4-H activity at the expense of my parent(s) or guardian{s). I alsounderstand that if I cause personal or public safety concems, I may lose my eligibility to participate insome future 4-H Youth Development events, andlor, lose my membership pivileges.

Prinl Membe/s Name

Membeds Signature Date

Pareni/Guardian's Signature Date

Revised July 2017, M. LesmeisterReviewed by: P. Rose, D. Haft, M. Lesmeister, R. Dixon, M. Livesay, D. White

OREGOff STAIE UNIVERSITY EXTE'VSiO'V SERY'CE OFFERS EDUCATTONAL PROGRAMS, ACTIVITIES, AND MATENALS WTHOUT DISCRIMINATIONEASED ON AGE, COLAR, DISABILITY, FAMILIAL OR PARENTAL STATUS, EENDER IDENNTY AR EXPRESSIAN, GENETIC INFORMATION, MARITALSTAIUS, NATIONAL ARIGIN, POLINCAL BELIEFS. p/.CE, REUG|ON, REPRISAL, SEX, SEXUAL ORIENTATION, YEIERAA/'S SIATUS, OR EECAUSE ALLOR APART OF AN NAVIDUAL'S /NCOME'S DENVED FROM N,IY PUBLIC ASS'SIANCEPROGRAM. OREGOA/ SIAIE U/V'VERS'ryEXIE''IS'OAISERVICE I S AN AA/EAENETERANSDI SABLED.

OFFICIAL 4-H HEALTH FORM Rev.1.2o1E

Name of evenUactivity

County-

E national (check one)

b, Jc LO

Type of activity: llounty/area p state "fl regional

Participant's Name:

Address:

First

Street Address

Zip Code

Participant is: tr nourtl_lroutnfltareG**","

Emergency Contact:

Home phone

Relationship

Daytime phone Even,ng phone

Cell'phone

Health Statement (to be com rysician or adult particDoes the participant have any dietary restrictions? lf yes, please describe: Yes No

Does the participant have any allergies? lf yes, please describe: Yes No

Name of all medications:

Name and phone number of physician:

As parent or guardian, if my child needs medical attention, I understand every effort will be made to contact me. I herebygive permission to the medical personnel selected by the person in charge of the 4-H event to order x-rays, routine tests,treatment, release any records necessary, and to provide or anange necessary related transportation for the persofinamed on this form. I hereby give permission to the physician selected by the person in charge of the 4-H event tohospitalize, secure emergency treatment for, to order injection, anesthesia, and/or surgery for me or my child as namedon this form. I will assume all financial obligations incuned if not covered by insurance.

Signature of ParenUGuardian or Adult participant Date

ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY

To the extentpermitted by laq and in consideration for being allowed to participate in the ACTIVITY, I hereby save, hold harmless,discharge and release the UNIVERS|TYfrom any and all liability, claims, causes of actions, damages or demands of any kind and naturewhatsoever that may arise from or in connection with my participation in any ac'tivities related to the ACTIVITY, whether caused by thenegligence or carelessness of the UNIVERSITY or othenrvise.

It is my express intent that this Acknowledgement of Risk and Waiver of Liability shall bind my spouse, the members of my family and my

estate, heirs, administrators, personal representatives and assigns. I further agree to save and hold harmless, indemnify and defend theUlllVER$lW from any claim by the aforementioned parties arising out of my participation in the ACTIMW.

I recognize and acknowledge that the UNIVERSITY makes no guarantees, warranties, representations, or other promises relative to the ACTIVITY,

and assumes no liability or responsibility for injury or property damage that I may sustain as a result of participation in the ACTIVITY.

I further understand and agree that this is a release of liability and indemnity agreement, and it is intended to be as broad and inclusive aspermitted by law. lf any portion hereof is held invalid, it is agreed thatthe balance shall, notrithstanding, continue in full force and legal effect.

I hereby certifi that with or without accommodation,* I have no health+elated reasons or problems that preclude or resfict my participation in the

ACTIVITY. I hereby consent to and understand myself to be solely responsible for the cost of first aid, emergency medical care, and, if necessary,

admission to an accredited hospital for executing such care or treatrnentfor injuries that I may sustain while participating in any activi$ associated

with the ACTIVITY.

OregonStateUnifersity

*lf your participation requires an accommodation, please

(7 days) before the date of the ACTIVITY.

Emergency Contact Name:

Darin Borgstadter, 503-37 7-7 920

Ente rprise Risk Serurbes

(541)737-7252risk,oregonstate,edu

Page 2 of 2

at least one week

(INSERT Depannent fr,nlacl nan,4- and phone rumber)

Telephone Number:

ln signing this Acknowledgement of Risk and Waiver of Liability I hereby acknowledge and represent (althat I have read this document

in its entirety, understand i[ and sign it voluntarily; and (b) that this Acknowledgement of Risk and Waiver of Liability is the entire

agreement between the parties hereto and its terms are contractualand not a mere recital.

Participant Signature:

=======:==========================:=========:=====:============ ==:=::=============:=================:======REQUIRED FOR ALL PARTICIPANTS UNDER 18 YEARS OF AGE:

PARENT OR GUARDIAN'S AUTHORIZATION FOR MED]CAL CARE AND CONSENT TO AGREEMENT

I cerli$ that I am the parent or legal guardian of the above-named participant in the ACTIVITY. 0n behalf of myself and my spouse, partner, co-

guardian or any other person who claims the participant as a dependen( I have read the above agreement, I understand the contents of this

Acknowledgement of Risk and Waiver of Liability, ass6nt to its terms and conditions, and sign this Acknowledgement of Risk and Waiver of Liability

of my own free act I acknowledge that my dependent and I have agreed to the terms and conditions of rny dependent's participation in the

ACTIVITY, and I hereby give my consentto participation by my dependent in the ACTIVITY, and to receive medical treatment determined to be

necessary. I further agree to hold harmless, indemnifr and defend the UNIVERSITY from and against all claims, demands or suits that my

dependent has or may have.

Parent or Guardian Signature:

This agreement may be executed in two or more counterparts, each of which is an original, and all of which together are deemed one and lhe same instrument.

COMPLETE BOTH SIDES OF THIS FORMERS N.20.17

OregonStateUnirTersity

ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY

TLtrJ{DE TKIN I

Actiuig: 4H CamB WhiE O* Ceu*selar Fr*grar*

Eaferprse ft*lr Services

1541)737-7252risk.*regcestate.edu

Page I of2

Gruup: Oregon &H Program Date{s}: ffiarch 2}26, 2020

Participantlnfonnation Name:

Street

Age: Sex:

ciff:

Hsi:e Ph**e:

SHe:

w*Ep:

eell Fh*ne.

Read this Acknowledgement af Risk and Waiver of Liability carefutty and in 'tts en{trety. lt is a binding tegal document. Ptease read bofh srdes of tilspage. SEn and retum this form to:

CampWhiteoak,DarinBorgstadte1oSU0regon4.HCenter,53g04-HRdNWs@

If1rora* wdrlr&eageof f$, Smfenpmtsf **sfgnedlyyo{resErspare#fa*fElEIi&gp:rp*e*f crfualgradi**.

l, the undersigned, am aware that participation in the Activity (hereafter refened to as ACTIVITY) described above may include activities that maycause injury and be dangerous. I acknowledge that paffcipation in this ACTIVITY has the following non-exhaustive listof particular activities thaibear risk and danger and from whieh bodily injury, up to and including death, may oecur (INSERT activities betow):Transpcrtatian may be provided by commercial bus, or state van. Classes will he in outdoor environments such as forests, meadows,and near ponds. Participants will be hiking to access study sites. Appropriate clothing and footwear should be provided by eachparticipant to be able to be comfortable in the out-of-doors for 50- 90 minutes or more.

With full kncdedge of the facts and circumstances surroundingthe ACTIVITY, I voluntarity participate in the ACTIVITY and assume tfieresponsihilitfes and risks resufting fuom my participation, including all rist of property damage and iniury tro others and to myself. I agreeto comply with all of the rules and conditions of participating in the ACTIVITY. I have adequate applicable insurance necessary to provide for and payany medical costs that may directly or indirecfly result from my participation in the ACTIVIW, or othenuise understand that I am solely responsible forany medical costs that may directJy or indirectly result from my participation in the ACTIVITY. I will indemnify Oregon State University, its ofiicers,board members, agents, and employees (hereafter refened to as UNIVER$ITY) harmless with respect to any and all claims, injuries, and costsassociated with my participalion in this ACTIVIW.

Furthermore, I acknowledge that I am solely responsible for any action that I participate in associated with this ACTIVITY or around this ACTIVITY,regardless if occurring before, during or after the period of the ACTIVITY. I will conduct myself in a manner that is considerate of other participantsand in accordance with UNIVERSIW Rules and Regulations (including Code of Sfude nt Conduct when applica0te) and with any federal, state,city and other applicable laws or rules where the ACTIVITY is occuning, lf this ACTIVITY is an off-campus UNIVERSITY sponsored event such asfield tips, conferences, research, experiential learning, extension of classroom learning, etc., I understand that conduct not acceptable in theclassroom setting is not acceptable during this ACTIVITY and will be handled in acccrdance with the Student Canduct Regulations. ln additjon, I

undemtand hat if I favel to the ACTIVITY with a UNIVERSITY group andlor advisor, I will retum wih the group unless prior anangements havebeen made with the UNIVERSITY faculty/staff who is s"upervising the ACTIVITY.

I recognize and acknowledge thatthe UNIVERSITY may record my participation and appearance in ACTIVITY on any recorded medium including,but not limited to video, audio, photos (collectively "recordings') for use in any form (including, but not limited to prinl websites, blogs, interne( socialmedia). I authorize such recording and release UNIVERSIry to use my name, likeness, voice, and biographical materialto exhibit or distribute suchrecordings in whole or in pa* without restie{ians cr limitalions ftr any educdiond ar promotiond pirpose. lf you would like to opt aut of this seclion,please requestthe Photo Opt Out Release.

I am aware that if I provide a vehicle not owned and operated by the UNIVERSITY for transportation to, at or from the ACTIVITY site, or if I am apassenger in such a vehicle, the UNIVERSITY is not responsible for any damage caused by or arising from my use of such fansportation.Furthermore, I acknowledge that I am solely responsible for any action that I take that is outside the scope of the scheduled ACTIVITY, regardless ifoccuning before, during or after the period of the ACTIVITY.

This agreement may be executed in two or more counterparts, each of which is an original, and all of which together are deemed one and the same instrumeni.

COITilPLETE BOTH SIDES OF THIS FORMERS 09.20.17