Counselor Application

All fields are required unless marked as (optional)

Counselor Information

Gender

Week Selection

T-Shirt Size

AYF Member?

Will you be able to attend counselor orientation from June 3, 2022 to June 5, 2022?

Emergency Contact #1

Emergency Contact #2

Camp Experience



 



 

Health Information

This information is confidential and will be used in case of emergency

Health History

Have you ever been hospitalized?

Additional Questions

Do you have any dietary restrictions?
If yes, please explain (optional):

Do you smoke?

Do you have any of the following certifications? (optional)
CPRFirst AidEMTLifeguardNursing

Have you ever been convicted of a crime?
If yes, please explain (optional):

Photo/Video Release Waiver

I hereby authorize Armenian Youth Camp to publish the photographs/videos taken of me and/or my name, for use in the Armenian Youth Camp website and social media accounts. I release Armenian Youth Camp from any expectation of confidentiality for myself and that I have the authority to authorize Armenian Youth Camp to use my photographs/videos and name. I acknowledge that since participation in publications and websites produced by Armenian Youth Camp is voluntary, I will not receive financial compensation. I further agree that participation in any publication and website produced by Armenian Youth Camp confers no rights of ownership whatsoever. I release Armenian Youth Camp, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of myself.

STAFF Code of Ethics and Conduct

Armenian Youth Camp (supported by the Armenian Cultural Foundation), was established to create a fun and safe environment that embraces the Armenian culture, encourages independence and nurtures lifelong friendships. As an AYC Staff member, you are an integral part of making the Summer Camp experience fun, safe, and positively memorable.
AYC maintains a zero-tolerance policy for illegal behaviors and any behaviors that endanger children. Armenian Youth Camp reserves the right to prosecute unlawful infractions and dismiss Armenian Youth Camp Staff members who violate the Code of Ethics and Conduct (“Code”) outlined here.
Possession of any of the following items are strictly prohibited and are grounds for the immediate dismissal of any Armenian Youth Camp Staff member:
• Alcohol: The possession, consumption or use of alcohol is not permitted on the campgrounds for any purpose at any time. Any staff member on camp property who is found to be under the influence of alcohol is subject to dismissal.
• Marijuana, illegal drugs or controlled substances: The possession, consumption or use of illegal drugs is not permitted on the campgrounds for any purpose at any time. Any staff member on camp property who is found to possess or to be using illegal drugs is subject to dismissal.
• Smoking: Armenian Youth Camp is a smoke-free environment. The smoking of cigarettes, cigars or any other substance on the campgrounds is prohibited.
• Firearms, replica firearms, knives (including pocket knives) or any other weapons: Weapons of any kind are not permitted on Armenian Youth Camp grounds. Any found will be immediately confiscated and the owner will be subject to dismissal.
• Fireworks, explosives or other flammable materials
• Pornography: The possession or is not permitted on the campgrounds at any time. Any found will be immediately confiscated and the owner will be subject to dismissal.
As an Armenian Youth Camp Staff member you serve as a role model to the children who encounter you; as such you should conduct yourself responsibly and behave accordingly.
The following are behavior guidelines to follow while volunteering as an Armenian Youth Camp Staff member:
• Fires are restricted to the campfire which can only be started by designated staff, and only in the designated campfire area.
• Armenian Youth Camp Staff members are required to stay within campgrounds at all times. Any departure from the camp facility requires express permission from the Camp Director.
• Armenian Youth Camp Staff members must be respectful and follow the direction and directives of the designated Director(s) during the Armenian Youth Camp session.
• Armenian Youth Camp Staff members must comply with all applicable federal, state, and local jurisdiction laws, statutes, ordinances, rules and regulations during the Armenian Youth Camp session.
• Language: Foul language in the presence of children will not be tolerated.
• Harassment: Armenian Youth Camp has a zero tolerance for harassment of any type. Harassing behavior, including bullying, cursing or defaming remarks, to other Armenian Youth Camp staff members is unacceptable. Harassing behavior targeted to campers is grounds for immediate dismissal.

-I agree that failure to abide by any of the items specified within this Code may result in my dismissal from the staff position, expulsion from Armenian Youth Camp, and denial of future return to the Armenian Youth Camp . I have read, understand and agree to abide by all the above rules.

-I understand that I am volunteering to provide direct and/or indirect supervision of children and/or young adults attending the camp sessions. And in that position, I take responsibility over the health and well-being of each person assigned to my care, and will put their needs and interest first when making decisions. I understand that in an emergency situation it is my primary responsibility to secure the safety of each camper assigned to my care, and to assist in the security of other campers and staff.

-I will refrain from participating in any activities that are contradictory to or violate any of the rules as set forth by the Armenian Youth Camp Committee and Armenian Youth Camp Management Board. And in my position, I will enforce the rules to all campers.

-I will follow the enclosed Armenian Youth Camp Child Abuse Policy Guideline as it relates to relations with the campers.

CHILD ABUSE POLICY GUIDELINE

This policy on child abuse was approved by the Armenian Youth Camp Committee and Armenian Youth Camp Management Board in order to help safeguard the health and well–being of all campers, counseling staff, program staff and directing staff participating in the Armenian Youth Camp.
Personal Rights
The Armenian Youth Camp Committee and Armenian Youth Camp Management Board endorses the following personal rights for all staff and campers. All staff and campers are entitled to:
• Dignity in person relationships with staff and campers.
• Safe and healthful accommodations, furnishing and equipment.
• Freedom from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with function of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physically functioning.
• Not be locked in any room, building or center premises by day or night.

Prohibitions
Inappropriate behavior or disciplinary measures, including but not limited to the following, shall be prohibited.
• Corporal punishment, including hitting, spanking, beating, shaking, pinching, and other measures that produce physical pain.
• Withdrawal or the threat of withdrawal of food, rest, or bathroom opportunities.
• Abusive or profane language.
• Any form of public or private humiliation, including threats of physical punishment.
• Any form of sexual abuse
• Any form of emotional abuse, including rejecting, terrorizing, ignoring, isolating, or corrupting a child. Any staff member must report any such known abuse immediately to the Armenian Youth Camp Director. Any staff member or camper engaging in such behavior faces dismissal by the Armenian Youth Camp Committee and Armenian Youth Camp Management Board.

Definition
The following are descriptions of four major type of maltreatment, all of which are strictly prohibited: Physical abuse, neglect, sexual abuse, and emotional abuse. While state definitions may vary, operational definitions include, but are not limited to, the following:
Physical Abuse
Characterized by the infliction of physical injury as a result of punching, beating, kicking, biting, burning, shaking, or otherwise harming a child. The parent or caretaker may not have intended to hurt the child; rather the injury may have resulted from over-discipline or physical punishment.
Child Neglect
Characterized by failure to provide for the child’s basic needs. Neglect can be physical, education, or emotional.
Sexual Abuse
Includes fondling a child’s genitals, intercourse, incest, rape sodomy, exhibitionism, and commercial exploitation.
Emotional Abuse (psychological/verbal abuse /mental injury)
Includes acts or omission by the staff, or could cause serious behavioral, cognitive, emotional, or mental disorders. Examples include extreme or bizarre forms of punishment, such as confinement of a child in a dark closet, as well as less severe acts, such as habitual scapegoat, belittling, or rejecting treatment.
1. Derived from the State of California Regulations for Child Care Centers
2. Derived from policies outlined by the Nation Resource Center for Health and Safety in Child Care, located at the University of Colorado Health Sciences Center in Denver, Colorado, and funded by the Maternal and Child Health Bureau, U.S Department of Health and Human Services.
3. Derived from the definitions provided by the National Clearinghouse for Child Abuse and Neglect.

AFFIRMATION
This document will go on file in your Armenian Youth Camp Staff file. It serves as proof that you have received and read the CHILD ABUSE POLICY GUIDELINE.
I have read and understand the Armenian Youth Camp CHILD ABUSE POLICY GUIDELINE. I understand that I am volunteer subject to all Armenian Youth Camp rules and regulations. I am aware that violation of these rules may subject me to disciplinary action or dismissal as specified above.

AYC Counselor Release of Information and Agreements

I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability in connection with same. I further agree to adhere to all Armenian Youth Camp regulations and to abide by all of the decisions made by the Armenian Youth Camp Committee, Camp Director, and Management Board. I understand that untrue, misleading, or omitted information herein or in other documents by the applicant may result in dismissal, regardless of the time of discovery by the camp. I also understand that this application will be void should I not attend the mandatory counselor orientation at Camp Sylvester April 14-15, 2018. All applicants are subject to mandatory drug testing prior to being approved as a counselor. Once approved, all counselors are also subject to random drug testing during their stay at camp.

Medical Treatment Release

You represent and warrant that you are in sufficient physical condition to safely participate in the Armenian Youth Camp Event, and have no medical condition that would make your participation in the Event more hazardous. You consent to medical care and transportation in order to obtain treatment in the event of injury to you and understand that this Agreement and Waiver extends to any liability arising out of or in any way connected with the medical treatment and transportation provided in the event of an emergency and/or injury. You understand that no medical care may be available, but if it is, you assume liability for any and all medical expenses incurred as a result of your participation in the Event (where such medical expenses are not provided on a free of charge basis by any medical services organizations, clinics, or hospitals), including, but not limited to ambulance transport, hospital stays, physician, and pharmaceutical goods and services. You agree to observe and obey all posted rules and warnings, to follow any instructions or directions provided to you by the Event organizer and to abide by any decision of any Event official relative to your ability to safely participate in or attend the Event. You understand and agree that you are expected to exhibit appropriate behavior at all times while at the Event and to obey all applicable laws while participating in or attending the Event. This includes, generally, respect for other people, equipment, facilities or property. You agree that Event officials may dismiss you, without refund, should your behavior, in the opinion of the Event organizer, endanger the safety of or negatively affect the Event. You understand and agree that you are responsible for taking care of your own personal belongings during the Event and, to the maximum extent permitted by law, the Event organizer is not responsible for any personal item or property that is lost, damaged or stolen at the Event. You understand and agree that the Event organizer reserves the right to cancel the Event in the event of weather (including, but not limited to, heat, tornadoes, earthquakes, fires, storms, lightning and floods), accidents, acts of war or terrorism, military conflicts or riots, or for any reason that would affect the safety and security of Event participants and/or spectators or the feasibility of the Event to be held. In the event of such cancellation or any other cancellation for any reason, there will be no refund of your payment unless authorized and paid by the Event organizer.

Camp Sylvester Waiver, Release and Indemnity

Fifth Edition, Effective October 2015

Waiver, release and indemnity

I understand and agree that my participation in events, programs, races, or activities organized, operated, conducted and/or sanctioned by Camp Sylvester is conditional upon my execution of this document.

1. I am aware that camping and related activities involve the possibility of injury or death.
2. I accepts these risks, and all others arising from these events and programs, even if arising from the negligence, gross negligence
or negligent rescue by those associated in any way with the Camp Sylvester events and programs I may be involved in, the venues
at which these events and programs takes place or by those organizing, officiating, or participating in these events and programs
throughout the year, including their respective officers, directors, employees, agents, servants, volunteers and representatives (the
“Releasees”).
3. I understand that all applicable rules for participation must be followed and that SOLE RESPONSIBILITY FOR MY PERSONAL
SAFETY REMAINS WITH ME, including my physical and emotional preparation and fitness to participate in all events and programs
throughout the year.
4. I undertake and agree to remove myself from participation if I sense or observe any unusual hazard or unsafe condition.
5. I give, a FULL RELEASE AND WAIVER OF LIABILITY AND ALL CLAIMS that I have, or may have in the future, against Camp Sylvester,
participating program organization, and all other Releasees from all liability for any loss damage, injury or expense that I may suffer
as a as a result of my participation in any part or parts of the events or programs or my presence at any venue at which they may
take place, due to any cause whatsoever including the forms of negligence set forth in paragraph (2) above or from any breach of
contract or statutory duty or other duty of care including any duty of care owed by the Releasees.
6. I AGREE NOT TO SUE and I further agree TO INDEMNIFY AND SAVE HARMLESS the Releasees from all expenses, fees, liability
or damage award or cost of any type whatsoever arising from my participation in these events or programs. I HAVE READ AND
UNDERSTOOD THIS WAIVER, RELEASE AND INDEMNITY. I am aware that by signing this agreement I am waiving substantial legal
rights (on my behalf and on behalf of the heirs, executors, administrators and next of kin), including the giving up of my rights to sue.

Camp Sylvester - General Facility Use Agreement (Continuation of previous (Front Side of reservation agreement):

7. Camper/Guest understands that Camp Sylvester and/or its employees do not provide cleaning services. It is NOT the duty or
responsibility of Camp Staff to clean facilities, bathrooms or any other buildings. Camper/Guest upon departure is required to
complete a comprehensive cleaning of all facilities used.
8. Camp Staff, will open and close Camp, instruct Camper/Guest on use of equipment and provide basic supplies including: electric
service (for general use), running water (hot water limited), toilet paper, paper towels, light bulbs, hand soap, hair and body wash,
appropriate surface and floor detergents and cleaner for sanitation management. Any equipment failures, or restock of supplies
shall be reported to Camp Staff.
9. All Campers/Guests to furnish bedding (sheets, blankets, sleeping bag and/or pillow), hygiene products, bathing towel, food or any
other item necessary.
10. Camper/Guest acknowledges and accepts that Camp facilities may be rented independently of other on-site facilities and services.
Camper/Guest agrees to maintain the privacy of other guests/groups that may be staying on site and will not intrude or interrupt
other guests and/or groups staying at Camp during the rental period. Rental of Camp does not include open use of other on site
areas not defined on the contracted Reservation Agreement such as: other recreation and/or dining halls, guest house cabins,
amphitheater, sport courts/fields and/or bathroom facilities.
11. Camper/Guest accepts and agrees to be responsible for all damages or injury done to persons or property while on the Camp
property. Camper/Guest understands Camper/Guest may be individually charged for damages and agree to pay for repair and/or
replacement of damaged property including labor and materials.
12. Camper/Guest understands all campfires must be within defined campfire rings. All open flame campfires must be attended at all
time and should be extinguished by midnight.
13. Camper/Guest understands all buildings used during your stay must be cleaned, swept and moped prior to departure. Buildings not
properly cleaned at departure will be assessed additional charges.
14. Camper/Guest agrees to only use Scotch Blue Painters Tape on surfaces for mounting of decoration and signage and agree not to
graffiti walls and/or bunks.
15. Camper/Guest agrees not to parking in fire lanes or emergency access routes, parking permitted in defined areas only (do
not park vehicles near cabins).
16. Camper/Guest agrees not to remove beds or furnishings from assigned cabins, buildings and/or designated areas.
17. Camper/Guest understands that area heating units are for use during cool season months (October-May) and will not be
available for use during the summer season unless determined necessary by Camp Staff.
18. Camper/Guest understands that additional rules and regulations are posted on site and will do their part to review and
understands these additional rules and regulations apply during their Event/Group stay at Camp.
19. Camper/Guest understands that no pets are allowed at Camp expected those certified for medical need (example: seeing
eye dogs).
20. Camper/Guest understands tampering with emergency and safety equipment is a punishable felony and may result in fines
up to $500.00 per occurrence/incident.
21. Camper/Guest understands that cleaning charges of $150.00 per occurrence and fines of $50.00 per occurrence will be
charged to the Applicant(s) for discharging fire extinguishers in a non-emergency.
22. Camper/Guest understands that National Forest Service Law defines that the hours between 10:00 PM – 7:00 AM are
‘Quiet Hours’ and Camper/Guest will respect Camp's neighbors and reduce excess noise during ‘Quiet Hours’. If excess noise
continues into 'Quite Hours', the Camper/Guest will be given warning to quite down. Camper/Guest and/or camper guests
who continue to generate excess noise as determined by Camp Staff will be removed from the property without refund.
23. Camper/Guest understands that National Forest Service Law does NOT permit the use of equipment that generate
amplified sound such as stereos, loudspeakers, DJ equipment or excessively loud / amplified instruments (example: drums,
electric guitar).
24. Camper/Guest understands that smoking is not permitted anywhere on or adjacent to the Camp site.
25. Camper/Guest understands that available vehicle parking is limited at Camp and Applicant(s) will do their part to organize
available carpools for guest campers.
26. Camper/Guest understands hot water for showers is limited and agrees to inform guests/campers to take short showers
when nessesary during large group visits.
27. Camper/Guest understands that Camp is located in a natural environment setting and is subject to Sierra weather conditions
including snow and heavy rains. Camper/Guest acknowledges that it is their responsibility to understand weather reports
and be prepared for unexpected weather conditions and its affect such as ground flooding and power outages.
28. Camper/Guest staying at Camp shall not arrive on site before designated check-in time and all guests and/or groups shall be
completely checked-out and off site by designated check-out time.

INDEMNITY AGREEMENT

I have read and understood the above waiver, release and indemnity, I too agree to waive, release and indemnify the Releasees, including Camp Sylvester and any related individual employee or agent thereof, in the terms set out above. I am aware that by signing this agreement I am waiving substantial legal rights, which I, our respective heirs, executors, administrators and next of kin may have against the Releasees.