Application - Adult Chaperone
APPLICATION FOR ADULT CHAPERON TRIPS and EVENTS |
What trip/activity/event are you applying for(DC, etc)_________________________ NAME:______________________________________________________________________ |
ADDRESS:___________________________________________________________________ |
PHONE # ______________________________ 4-H CLUB: _________________________ |
1. List your 4-H involvement at the club level
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2. List your 4-H involvement at the county level
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3. List other involvement or responsibilities you have with youth
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4. What other community organizations are you involved with
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5. Please list any special qualifications you have for this job (first aid, etc)
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6. Are you willing to help plan the next trip? In what capacity?
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7. Please write a brief paragraph stating why you would like to chaperon this group of youth and what you hope to bring back to Valley County.
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We would like you to make a report at a 4-H Council Meeting after the trip.
Signature:________________________________Date: ___________________________