2007 Marin County 4-H Summer Camp

2010 MARIN COUNTY 4-H SUMMER CAMP Camping program – Sunday, July 10 to Saturday, July 16 , 2011

Camp Staff Time Commitment – Sunday, July 10th, to noon on Saturday, July 16th -2011 Please note that as a camp staff person you will be responsible for a portion of the program. As a camp staffer, you must attend all of the training meetings and the overnight training weekend. Please do not make any plans to leave camp during the week. This is a disruption to the program and sets a bad example for the campers. If you have an unavoidable activity (school orientation, for example) then we require that a parent pick you up and bring you back. Also please do not make arrangements to leave early – camp is over at 11:00 am on Saturday. Staff Training Weekend – April 30 – May 1, 2011 (required) Camp Staff Fee - $165.00 At our Marin County 4-H Camp, Campers who are 14 years old by July 10, 2011 or entering 9th grade in Fall 2011, and have one year camp experience, assume some responsibility for the operation of the camp. These responsibilities are called STAFF positions. Being a STAFF member gives you the opportunity to learn and practice your leadership skills and provide a meaningful and motivating program for the young campers. We urge interested teens to apply for staff positions that are described in this flyer. As you review the available camp staff positions and make your choices, please remember “CAMP IS FOR THE CAMPERS”. The program, facilities, and staff are all geared to the needs and activities of the camper. Camp Staff will be expected to arrive on Sunday, July 10 between 9:00 AM and 10:00 AM, and stay through Saturday, July 16th at 11:00 AM. Teen staff members may not leave the campgrounds during this time period except in an emergency with the approval of the Camp Adult Supervisor and accompanied by a Parent/Guardian. To apply for a camp staff position, teens need to complete the enclosed CAMP STAFF APPLICATION, along with REGISTRATION/MEDICAL FORMS, CODE OF CONDUCT, AND WAIVER OF LIABILITY FORM, and return them to Camp Clerk, Eileen Castelli, 840 Bowen Ct. Sonoma, CA 95476. Along with the camp fee NO LATER THAN March 1, 2011

TEEN CAMP STAFF POSITIONS CAMP DIRECTOR: Responsible for successful coordination of all camp activities with teen and adult staff. Keeps camp running on schedule, is responsible for making a daily schedule poster for all to see, makes a daily camp inspection, announces daily programs at designated times and maintains order at program activities. Directors will assist the Campfire Directors as needed, and will lead a session. Must attend Staff Training weekend. BOYS’ OR GIRLS’ SUPERVISOR: Work closely with Camp Director and have full charge of respective sleeping areas. Accompany Camp Director on daily camp inspections. Instruct and assist tribes with sanitation procedures. Make certain campers are in their bunks at rest period and after lights out, and pays attention to the schedule and when campers need to be out of camp areas for programs, activities, tribe meetings, and fire drills. Is responsible for leading a session. Must attend Staff Training weekend. SPECIAL EVENTS DIRECTOR(S): In charge of the overall Special Events program that includes planning, delegation of sub-assignments, and coordination of each nights’ events as scheduled by the Special Events committee. Is responsible for all decorations at camp, and facilitates all aspects of tribe competition (including prizes). Works closely with Special Events Advisor. Must attend Staff Training weekend.

1 CAMPFIRE DIRECTOR(S): With the Camp Director, plan and implement all Campfire Programs during camp. Plan campfire agendas before camp and work with tribe leaders to have wholesome, entertaining campfires. Responsible for campfire building, serves as masters of ceremonies and song leaders at all campfires, and maintains order during campfire programs. Is responsible for leading a session. Must attend Staff Training weekend.

Those leading a session will choose sessions after staff positions are selected. TRIBE LEADERS: Assist with registration and conduct welcome activities. Greet tribe members upon arrival and help them get settled. Act as big brothers/sisters during camp. Work with other tribe leaders and supervise all tribe activities. Have all ideas and plans for the tribe ready prior to camp. Preside over tribe meetings and help generate spirit and enthusiasm in tribes. Must attend Staff Training weekend.

* NATURE ASSISTANT: Must attend all hikes and help the Nature Advisor with any nature activity.

* SPORTS ASSISTANT: Must be at the pool for polar bear and all free time swims to aid the lifeguard in watching the children.

* CRAFTS ASSISTANT: Help Craft Advisor during craft activities.

* MEALTIME FUN: Plan and lead activities at mealtimes as needed. Keep control of the Dining Hall at all times.

* MEALTIME COORDINATOR/DISHWASHER: In charge of dining area. Assist tribes with Prep and Serve and direct KP activities. Have dining area ready for next program.

* DISHWASHER: Supervise KP after each meal. Make sure dining area is in order and set up before each meal. (Free camp)

* These staff members will be placed in tribes

Your participation at last year’s staff training, and the performance of your duties at last year’s camp will have a major impact on your being selected for the job that you want at this year’s camp. If you are selected for a staff position you will be expected to attend all of the staff-training activities and the overnight weekend Apr. 30 – May 1, 2011 at the 4-H Camp.

Camper applications will go out in early April. If you have a sibling or know someone who’d like an application contact Eileen at the following address.

Eileen Castelli, Camp Clerk [email protected] 707/996-0354

Keep this page for your information

2 2011 MARIN COUNTY 4-H CAMP STAFF APPLICATION POSITIONS DESIRED: 1st Choice

2nd Choice

3rd Choice

Name______Currently Enrolled In 4-H Club/Group Address Street or PO Box City Zip Telephone School

Email: Grade you will complete June 2011 Date of Birth Age as of 7/10/11 Sex: male female Years at Marin Co. 4-H Camp (include this year) ______as Jr. Staff? List the programs you are in this year: (i.e. sports, 4-H groups, drama, etc.):

List the activities that you have attended so far this year that will help you be a better staff member:

Tell why you would like to serve in a 4-H Camp Staff position:

List programs or events you would be willing to lead at camp this year:

______

List up to 4 areas/ideas/strengths you want /need help in or you think would make a better camp:

______If applying for Camp Director, Boys’ or Girls’ Camp Supervisors, or Special Events Directors tell why you are qualified for this staff position:

3 Tell about your major interests and activities:

Return this application to the Camp Clerk no later than March 1, 2011 CODE OF CONDUCT MARIN COUNTY 4-H CAMP RULES LAS POSADAS STATE FOREST, ANGWIN, CALIFORNIA 1. Be polite and considerate of others and do not push people, throw rocks, food, or any other items. 2. Sexual harassment if never permitted. Never use racial, sexual, or religious slurs. 3. Respect the authority of adults. 4. Respect the property of others and do not disturb it. 5. Respect the wildlife and do not harm any animals. 6. Practice safety: firecrackers, fireworks, slingshots, guns and knives are not allowed. 7. Preserve our camp atmosphere – do not bring alarm clocks, hair dryers, curling irons, junk food, drinks, radios, Walkman, Discman, headphones, electronic games, pagers, and cell phones. 8. Respect the camp schedule and always stay with the tribe or program to which you are assigned. 9. Closed toe shoes are required at all times. “Flip flops” may be worn in the shower only. 10. You may leave camp only with the permission of the adult Camp Supervisor and with an adult chaperone, parent or advisor to accompany you. 11. Hikers require permission from the Nature/Hike Leader; must sign out/in, and must be accompanied by two adults. Long pants, socks, and sturdy shoes will be worn on all hikes. 12. Alcohol and illegal drugs may not be brought to camp or be used at camp. 13. Smoking by campers is not permitted and chewing tobacco may not be used anywhere at camp. 14. Practice safety: walk (do not run), and stay on trails. 15. Parking lot is off limits. No loitering or using vehicles while at camp. 16. Campers will remain in their assigned sleeping areas at night. 17. No boys in girl’s sleeping area, and no girls in boy’s sleeping area at any time. 18. Per 4-H policy, section 819, the person and property of all 4-H Youth Development Program (YDP) participants (both youth and adult) are subject to search during the course of 4-H YDP events if deemed necessary by 4-H YDP appointed volunteers and/or staff. The penalty for infraction of these rules may result in any or all of the following: a. Confiscation of inappropriate materials b. Punishment as determined necessary by the Camp Review Team c. Your parents will be called to come and take you home d. You will be disaffiliated from the Marin County 4-H Youth Program

I HAVE READ THE CAMP RULES AND AGREE TO ABIDE BY THEM WHILE ATTENDING THE MARIN COUNTY 4-H CAMP. ______Camper’s Signature Date ______Signature of Parent or Guardian Date Please return all FORMS and FEES to: MARIN CO. 4-H CAMP, c/o EILEEN CASTELLI, 840 BOWEN CT. Sonoma, CA 95476. Telephone 707/996-0354. Email: [email protected] Please check that the following are included with this form:

4 _____Signed code of conduct _____Camp application/medical form _____Waiver of Liability form _____Camp fee - $165.00 per camper

5 2011 FOR YOUTH STAFF ONLY 2011 July 10-16, 2011 YOUTH REGISTRATION AND MEDICAL TREATMENT FORM MARIN COUNTY 4-H CAMP

Name______Currently Enrolled in 4-H Club (name) Address

City Zip Phone ( )

Birth date: ______Age:______Sex: Boy Girl Grade Completed 6/10

Yrs. in 4-H: Years at MARIN Co. 4-H Camp: ______School

Ethnicity: (X) Native American______Hispanic_____ Black______White______Asian/Pacific Islander______

Vegetarian? Food Allergy? What food(s)

T-shirt Size (adult sizes only) Small Medium Large X-large XX-large (A T-shirt and camp picture is included in the camp fee)

REGISTRATION: COMPLETE ONE FORM PER CAMPER. After completing both sides of this form mail it with your Code of Conduct, Waiver of Liability and Camp Fee of $165.00 (made payable to MARIN COUNTY 4-H CAMP FUND) to MARIN County 4 - H Camp, C/O Eileen Castelli, 840 Bowen Ct. Sonoma, CA 95476. Application and fees due by March 1st No refunds after July 1, 2011.

I hereby certify that my child is in good health and can travel to and participate in this 4-H function. While my child is attending or traveling to or from this 4-H function, I HEREBY AUTHORIZE THE ADULT 4-H LEADER OR STAFF MEMBER, or in his/her absence or disability, any adult accompanying or assisting him/her, TO CONSENT TO THE FOLLOWING MEDICAL TREATMENT FOR SAID MINOR: Any X-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medical Practices Act, California Business and Professions Code section 2000 et seq.; or any X-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered by a dentist licensed under the provisions of the Dental Practices Act, California Business and Professions Code section 1600 et seq. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until my child completes his/her activities in this program unless sooner revoked in writing. I understand that as a parent/legal guardian, I will be responsible for the cost of any service or treatment provided not covered by the 4-H Youth Accident Insurance Program sponsored by the University of California Cooperative Extension. I understand that participation in 4-H activities includes activities around animals and in the outdoors, and all the risks that accompany such activities. I therefore waive any claims and agree to release and hold harmless The Regents of the University of California 4-H Program, its officers, agents, and employees from any liability whatsoever. ______AUTHORIZATION AND CONSENT AND RELEASE ______date signature of parent/legal guardian emergency phone DAY

please print name

MAILING ADDRESS CITY ZIP emergency phone NIGHT

Should there be any changes in the status of parent/legal guardian, it will be my responsibility to keep the camp clerk informed. PLEASE COMPLETE THE HEALTH HISTORY INFORMATION ON THE REVERSE SIDE.

University policy and the state of California Information Practices Act of 1977 requires the following information be provided when collecting personal information from you about your child The information entered on this form is collected under authority of the Smith-Lever Act. Submission of the medical data is voluntary. However, a signature is required on the signature line above. Failure to provide the medical information and authorization may result in our inability to provide ''ceded medical treatment. You have the right to review university records containing personal information about you/your child, with certain exceptions as set forth in policy and statute. Copies of university policies pertaining to the collection, use, or release of personal data are available for your examination at the Division of Agriculture and Natural Resources, 4-H, DANR, North Central Region, university of California, Davis, California, 95616 Only your own/your child's records are open to your 6 review. Any known or foreseeable intergovernmental transfer which may be made of the information is as follows: None.

7 HEALTH HISTORY INFORMATION

Name of Camper______SS# (optional)______

Parent e-mail address (please print):______

Is child subject to: Yes No Does child now have or has child ever had: Yes No

Colds...... Heart trouble...... Sore Throat...... Asthma...... Fainting spells...... Lung trouble...... Bronchitis...... Sinus trouble...... Seizures...... Hernia (rupture)...... Cramps...... Appendicitis...... Allergies...... Has appendix been removed?......

Is the child currently under any type of medical treatment? ......

Is there any history of behavior disorders or emotional disturbances, such as difficulties in relationships with authority figures or peers, or abnormally severe moodiness?......

Has the child been under psychiatric treatment within the past three years?......

List when child was vaccinated for: Diphtheria Tetanus Polio MMR (Measles/Mumps/Rubella)

Please identify child's allergies, including allergies to foods, medications, or drug reactions you know about:

Please list any physical disabilities or disorders that may limit your child's activities at this 4-H function, such as eyesight, hearing, speech, paralysis, diabetes, ulcer, etc.:

Please list all medications the child is presently taking: *Please bring medications to camp clearly marked in their original container to be given to the camp nurse for distribution. If your child uses an inhaler, please bring two – one for the nurse and one for the child to carry.

Remarks and any special instructions. Please explain "Yes" answers on this page.

In accordance with applicable State and Federal laws and University policy, the University of California does not unlawfully discriminate in any of its Policies, procedures, or practices on the basis of race, religion, color, national origin, sex, marital status, sexual orientation, age, veteran status, medical Condition or disability. Inquiries regarding this policy may be addressed to Affirmative Action Director, University of California Division of Agriculture and Natural Resources, 300 Lakeside Drive, 6th Floor, Oakland, CA 94612-3560.

Issued in furtherance of Cooperative Extension work. Acts of May 8 and June 30, 1914. In cooperation with the U.S. Department of Agriculture. W.R. Gomes, Director of Cooperative Extension University of California.

8 Participant’s Name______Please print

UNIVERSITY OF CALIFORNIA DIVISION OF AGRICULTURE & NATURAL RESOURCES 4-H Youth Development Program Marin County Cooperative Extension

Waiver of Liability, Assumption of Risk, and Indemnity Agreement

Waiver: In Consideration of being permitted to participate in any way in California 4-H Activities and Projects, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue The Regents of the University of California, its officers, employees, and agents from liability from any and all claims including the negligence of The Regents of the University of California, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in California 4-H Activities and Projects.

______Signature of Parent/Guardian of Minor Date Signature of Adult Participant Date

Assumption of Risks: Participation in California 4-H Activities and Projects carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions 3) catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in California 4-H Activities and Projects. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD The Regents of the University of California HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in California 4-H Activities and Projects and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

______Signature of Parent/Guardian of Minor Date Signature of Adult Participant Date

Participant’s Age (if minor) ______