Greetings! ,
Thank you for your interest in volunteering your time to Camp Star Trails. The single most important element to the success of our program is our camp staff. The enthusiasm, creativity, energy and spirit provided by our staff have given our campers wonderful times and cherished memories.
Our counselors come from a variety of backgrounds and experiences; but they all have one thing in common - a love of children and of the special experiences of childhood. I want to assure you that a medical background is not required. We have a health care team at the camp at all times. They take full responsibility for all medical needs, from chemotherapy to stomach aches. The counselor's responsibility is the child, not the cancer or its therapies.
Camp is one week, with 160 campers and approximately 90 total counselors and staff members. The campers are divided by age and sex into cabins. There are usually 8 to 10 campers and three or more counselors to a cabin, depending on the age of the campers. Also, each cabin will have at least one experienced counselor to serve as a Resource Counselor. The cabin becomes the family unit, promoting a sense of belonging, and teaching the campers how to live together. The activities offered throughout the day promote independence and develop skills. The evening activity, which includes the whole camp, enhances a sense of community.
Camp dates are Sunday, June 22 - Saturday, June 28, 2014. New Counselors are required to arrive at the campsite on Saturday, June 21 at 3:00 PM for training and set up.
Once we have received your completed application and reference, you will be contacted for an interview. Please return your forms to Please return to: Camp Star Trails-Unit 87 ● Children’s Cancer Hospital at UT M. D. Anderson Cancer Center ● 1515 Holcombe Blvd. ● Houston, TX 77030-4009. If additional information is needed, I can be reached at (713) 792-3362.
Again, thank you for your interest,
Lauren Shinn, MS, CCLS
Child Life Specialist for Camps and Special Events The Children's Cancer Hospital
MD Anderson Cancer Center 1515 Holcombe Blvd.
Houston, TX 77030 713-792-2906
POSITION DESCRIPTION
CAMP COUNSELOR
SUMMARY
Function:
Provides Assistance and leadership to Camp Star Trails’ program.
Scope:
Assists in planning and implementing program activities. Focus on providing a safe and
supportive camp environment for children with cancer and their siblings.
ESSENTIAL FUNCTIONS
Serves as counselor in residence to a group of campers, sharing responsibilities of all cabin
assignments with co-counselors.
Uses interpersonal and communication skills to create a group/team environment in cabin and camp as
a whole and establishes rapport with assigned campers.
Provide leadership in cabin and Camp program activities.
Assists Staff and Activity Leaders through actively participating and supervising program activities.
Maintain a safe environment for cabin and the entire camp. Must be able to visually and aurally assess
campgrounds to ensure safe surroundings. Requires the ability to visually observe camper’s activities.
Requires the ability to verbally communicate and aurally hear camper’s replies.
Participate in the planning and implementation of camp programming.
Encourages respect for personal property, camp equipment and facilities.
Monitor camper’s health and condition with the Health Center Staff.
MARGINAL FUNCTIONS
Provides support to other cabins if needed.
Requires ability to lift campers, move equipment and supplies up to 80 lbs.
Assist Staff and Program Leaders with preparation of activities and special programs.
Perform other duties as assigned.
WORK BEHAVIORS
Must have the ability to work with children and understand their needs regardless of physical abilities,
race, or economic status.
Position requires the ability to place the needs of the campers and the Camp ahead of personal
desires.
Position requires flexible, patient and empathetic to the needs of camp attendees
.
EDUCATION
High school graduate or equivalent
EXPERIENCE
Camp experience or work with children preferred but not required.
_________________________________________________________________________________________________________________
NEW COUNSELOR APPLICATION
Camp Dates: June 22-28, 2014(Please Print)
DATE: ___________________20_____
Name: ____________________________________ _________ _______________________________________
First Middle Initial Last
Home Address: ____________________________________ ____________________ __________ ___________
Street / Apt. No. City State Zip
Home Phone: (_____)____________ Cell Phone: (_____)______________ E-Mail: __________________________
Employed By/ ____________________________________ ____________________________________________ Attend School Company/School Address
Position Held: (_______) _______________________ Business/School Phone: (______) ___________________
Education
Name & City of School Years Attended Diploma/Degree Area of Concentration
How did you hear about Camp Star Trails? ________________________________________________________
Have you worked at a medically supervised camp or have any camp counseling experiences? If yes, where, when, and describe your role:
____________________________________________________________________________________________ ____________________________________________________________________________________________
List your activities & skill level if applicable
Beginner Intermediate Advanced
Foreign Language
Sign Language
Clubs / Organizations
Please indicate age groups in which you have experience/interest:
Ages 5-6 7-8 9-10 11-12 Circle your choices
Experience Boy or Girl Boy or Girl Boy or Girl Boy or Girl Interest Boy or Girl Boy or Girl Boy or Girl Boy or Girl
CONSIDERATIONS ON TAKING UP THE ROLE OF COUNSELOR
Working with a child with chronic, debilitating and/or life threatening illness is a challenging and unique experience. It can create a variety of feelings and questions within yourself and your life. It is an essential part of the role of counselor to be aware of your own feelings and reactions to children with cancer.
The followings questions will give you an opportunity to think about some of your previous experiences and reactions. Please consider these carefully, and then share your thoughts with us. Your responses will provide us with a better understanding of who you are and how you might deal with the responsibility of this role.
Have you had personal and/or professional experiences with children or adults who had chronic, debilitating, and/or life threatening illness? If so, please briefly describe your role in these instances.
____________________________________________________________________________________________ ____________________________________________________________________________________________
What do you think motivates your decision to be a camp counselor? How does your experience with illness as mentioned above, fit into your decision?
____________________________________________________________________________________________ ____________________________________________________________________________________________
Would you be comfortable working with new people? Would you provide or require support? Are you self-directed? ____________________________________________________________________________________________ ____________________________________________________________________________________________
Is there anything else you want us to know about you, your goals or ideas for yourself at camp?
____________________________________________________________________________________________ ____________________________________________________________________________________________
Have you ever had any license, certificate or employment suspended, revoked, terminated or adversely affected? Yes _____________ No _______________ If yes, provide a full description including dates and circumstances: ____________________________________________________________________________________________ ____________________________________________________________________________________________ Have you been previously convicted of a felony or misdemeanor? Yes _____________ No _____________ If yes, provide a full description including convictions, dates, and circumstances: ___________________________ ____________________________________________________________________________________________
APPLICANT'S CERTIFICATION AND AGREEMENT Please Read Carefully
I __________________________________________________, hereby authorize Camp Star Trails to obtain information pertaining to any charges or convictions I may have for federal and state criminal law violations. This information will include but not be limited to allegations and convictions committed upon minors, and will be gathered from any law enforcement agency of this state or any other state or federal government to the extent permitted by state and federal law.
I also authorize all persons, public agencies, courts, schools, employer companies, and corporations to supply verification of the information provided in my application as well as evaluation of my prior performances, and I release them from all liability from their doing so.
The above statements are true and complete to the best of my knowledge.
Upon the offer of a Counselor position, I understand that I must supply the camp with insurance verification. Any falsification, misrepresentation, or incompleteness in this disclosure is alone grounds for disqualification. The information that I have provided may be verified, in necessary, by contacting persons or organizations named in this application.
Have you been previously convicted of any crime related to the abuse, mistreatment, or molestation of children? Yes __________ No ________If yes, provide a full description including convictions, dates, and circumstances: ____________________________________________________________________________________________ ____________________________________________________________________________________________
Signature: _____________________________________________________ Date: _______________________ ALL INFORMATION WILL BE HELD CONFIDENTIAL, UNLESS SPECIFIED OTHERWISE.
NOTIFICATION OF PERSONAL BACKGROUND CHECK
I hereby authorize The University of Texas Police Department or any other police agency to furnish The University of Texas Police Department any criminal history they have concerning me. I further release all agents and employees of The University of Texas M. D. Anderson Cancer Center, the person in charge of such police agency or department from all liability resulting from the furnishing of this information to The University of Texas M. D. Anderson Cancer Center.
I understand that the criminal history information request shall be handled by the Chief of Police of The University of Texas M. D. Anderson Cancer Center who shall be responsible for the confidentiality of such information.
Only the University of Texas M. D. Anderson Cancer Center Police Department will have access to the files. and neither I, nor any other individual except by court order, will be allowed to see the information in these files for any reason. I understand that if after review of the information, the Chief of Police determines that I represent a risk to the Institution; I will be deemed unsuitable for the position and will be separated or removed from consideration
Applicant’s Name (Please Print)
Applicant’s Date of Birth
This date is a requirement of the Department of Public Safety and will be used only for the purpose of a criminal history inquiry.
Applicant’s Signature Date
Camp Star Trails Representative Date
Sex: Male Female
Race/Ethnic Category:
White (Not of Hispanic Origin) - Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East
Black (Not of Hispanic Origin) - Persons having origins in any of the Black racial groups of Africa.
Hispanic - Persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.
Asian or Pacific Islander- Persons having origins in any of the original peoples of the Far East. Southeast Asia. the Indian Subcontinent, or the Pacific Islands (examples: China.
Japan, Korea. India, the Philippine Islands, and Samoa).
HEALTH QUESTIONNAIRE
In case of an emergency, please notify:
Name Relationship
( ) - ( ) - ( ) -
Home Phone Work Phone Fax Number
Physician’s Name: ( ) - Phone Number
If a patient here, identify your
Center Station: ____________________ Name of Doctor: ______________________ Phone: _________________ 1. Have you had any serious health problem that would keep you from volunteering?
Yes
NoIf yes, please describe: _______________________________________________________________________
2. Date of last physical examination: _____________________ Results: _______________________________
3. Immunizations:
H1N1 Flu Vaccine……….
Yes
NoMMR (measles, mumps, and rubella)...
Yes
No Poliomyelitis...………
Yes
NoTetanus...………….
Yes
No4. Have you ever had
or
do you now have any of the following?Chicken pox...
Yes
No Skin infections, rash or boils....
Yes
No Dizziness or fainting spells...
Yes
No Shortness of breath...
Yes
NoPain in chest, palpitations...
Yes
No Convulsions...
Yes
No Backaches or back surgery...
Yes
No High blood pressure...
Yes
No Herpes zoster (shingles)...
Yes
No Tuberculosis...…..
Yes
NoDiabetes...
Yes
No Date of last screening: Are you under medication?
Yes
No5. Are you taking any medications of which we should be aware?
Yes
No If yes, name of medication: __________________________________________________________________________________________I hereby certify that the above is true and complete to the best of my knowledge. I realize this information is confidential.
PERSONAL REFERENCE for COUNSELOR APPLICANT
APPLICANT'S NAME: ___________________________________________________________________________
The above person has given us your name as a personal reference for a counselor position at Camp Star Trails, an -overnight weeklong camping program for children with cancer and their siblings, ages 5-12. We hope you will carefully evaluate the applicant for us. Our goal is to provide quality staff to maintain the high program and safety standards of Camp Star Trails.
Please read through the following categories. Check as many descriptions as you feel apply to the applicant. If these areas do not describe the applicant, please feel free to comment.
1. WORKING WITH OTHERS 2. WORK ETHIC
____Prefers to do things themselves ____Takes direction well
____Is a team player ____Self-motivated
____Cooperative ____Committed and follows through
____Flexible ____Difficulty completing work
____Shares accomplishments ____Able to identify and solve problems Other comments______________________ ____Takes on new challenges willingly ____________________________________ Other comments_________________________ ____________________________________ _______________________________________
3. ENTHUSIASM 4. MATURITY
____Even disposition ____Responsible, able to think things through ____Has energy that motivates others ____Reacts without thinking about actions ____Enthusiastic, but insincere ____Is a positive adult role model for others
____Tires easily ____Is able to relate well to others
____Little outward enthusiasm, but well motivated. ____Able to control emotions
____Not very enthusiastic ____Remains effective under pressure
Other comments______________________ Other comments__________________________ ____________________________________ ________________________________________ ____________________________________ ________________________________________
5. COMMUNITY/CONFLICT 6. LEADERSHIP
____Is willing to accept others regardless of difference ____Has leadership abilities
____Seeks positive resolution ____Considers others opinions to conflict important ____Lets problems build up ____Is dominant and/or manipulative at times
____Shows favoritism ____Uses temper as a leadership tool
____Works to strengthen group ____Would rather be a follower than a leader ____Recognizes limitations and seeks support ____Demonstrates consistency
Other comments_____________________________ ____Knows when to step in and take control ___________________________________________ ____Doesn't know when to step back
___________________________________________ Other comments________________________
______________________________________
7. COMMUNICATION SKILLS
____Is sensitive to others Other comments________________________ ____Needs to share their own stories ______________________________________
____Good Listener ______________________________________
____Mixes easily with others ______________________________________ ____Believes trust must be earned
____Seeks others input
8. How long have you known the applicant? In what capacity?
____________________________________________________________________________________________ ____________________________________________________________________________________________ 9. What is the applicant's strongest asset? _________________________________________________________ 10. What is his/her chief weakness? _______________________________________________________________ 11. Any special talents? ________________________________________________________________________ 12. What aspect of the counselor role do you perceive to be the most difficult for this applicant?
____________________________________________________________________________________________ ____________________________________________________________________________________________ 13. Would you be willing to have your child under her/his supervision at camp for one week? Why?
YOUR NAME: __________________________________________ PHONE: (_____) ______-_______________
Please return to: Camp Star Trails-Unit 87 ● Children’s Cancer Hospital at UT M. D. Anderson Cancer Center ● 1515 Holcombe Blvd. ● Houston, TX 77030-4009
