Greetings!, Again, thank you for your interest,

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1 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, 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 If additional information is needed, I can be reached at (713) 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

2 POSITION DESCRIPTION CAMP COUNSELOR SUMMARY Function: Scope: Provides Assistance and leadership to Camp Star Trails program. 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. High school graduate or equivalent EDUCATION EXPERIENCE Camp experience or work with children preferred but not required.

3 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: ( ) 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? (Over)

4 Have you worked at a medically supervised camp or have any camp counseling experiences? If yes, where, when, and describe your role: Foreign Language Sign Language Clubs / Organizations List your activities & skill level if applicable Beginner Intermediate Advanced Please indicate age groups in which you have experience/interest: Ages 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?

5 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. Thanks for your interest. We will be in touch.

6 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). American Indian or Alaskan Native - Persons having origins in any of the original peoples of North America

7 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 No If yes, please describe: 2. Date of last physical examination: Results: 3. Immunizations: H1N1 Flu Vaccine. Yes No MMR (measles, mumps, and rubella)... Yes Poliomyelitis... Yes No Tetanus.... Yes No No 4. 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 No Pain 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 No Diabetes... Yes No Date of last screening: Are you under medication? Yes No 5. 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. Signature: Date:

8 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 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 Is a team player Cooperative Flexible Shares accomplishments Other comments Takes direction well Self-motivated Committed and follows through Difficulty completing work Able to identify and solve problems Takes on new challenges willingly Other comments 3. ENTHUSIASM 4. MATURITY Even disposition Has energy that motivates others Enthusiastic, but insincere Tires easily Little outward enthusiasm, but well motivated. Not very enthusiastic Other comments Responsible, able to think things through Reacts without thinking about actions Is a positive adult role model for others Is able to relate well to others Able to control emotions Remains effective under pressure Other comments (Over)

9 5. COMMUNITY/CONFLICT 6. LEADERSHIP Is willing to accept others regardless of difference Seeks positive resolution Lets problems build up Shows favoritism Works to strengthen group Recognizes limitations and seeks support Other comments Has leadership abilities Considers others opinions to conflict important Is dominant and/or manipulative at times Uses temper as a leadership tool Would rather be a follower than a leader Demonstrates consistency Knows when to step in and take control Doesn't know when to step back Other comments 7. COMMUNICATION SKILLS Is sensitive to others Needs to share their own stories Good Listener Mixes easily with others Other comments 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

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