Which programs/projects would you like to help with? Please select all that you are interested in.*
Volunteer summer camp counselor (June and July dates available)
Outdoor School Assistant (various weekdays from 9-1:30pm during school season)
Grounds improvement project (group volunteer projects)
Event Help - Camp Fired Up - October 5, 2018 from 5-9pm
Spring/Fall break camp counselor - dates TBD
When are you available to volunteer with us? *
Are you at least 16 years of age?
Where did you hear about volunteering with Camp Fire?
T- Shirt Size
State / Province*
State / Province*
Place of Employment
Social Security #
Other names by which known
Drivers License #
Emergency Contact Name
Emergency Contact Phone Number
Have you ever been convicted of any crime relating in any manner to children and/or your conduct with them?
Have you ever been convicted of any crime including, but not limited to, those listed below and/or any crime similar in any manner to those listed below?
Indecent assault and battery on a child under fourteen
Indecent assault and battery on an individual with a intellectual disability.
Indecent assault and battery on a person who has obtained the age of fourteen
Rape of a child under sixteen with force
Assault with intent to commit rape
Kidnapping of a child under sixteen with intent to commit rape
Distribution and trafficking of narcotics or other controlled substances
Intent to commit any of the above crimes.
Have you ever been adjudged liable for civil penalties or damages involving sexual or physical abuse of children?
Are you now or have you ever been subject to any court order involving sexual or physical abuse of a minor, including, but not limited to a domestic order or protection?
Have your parental rights ever been terminated for reasons involving sexual or physical abuse of children
If yes to any questions above, please explain
I understand that:
Camp Fire may deny employment to any person who answers “yes” to any one of questions 2-6. If hired and the employer later discovers circumstances that would indicate a “yes” answer to any of the above questions, employment may be terminated immediately.
The information provided on this form is subject to verification, which may include a criminal history check and request from any Central Registry of child abusers.
The camp may terminate employment or volunteer service of any person if that person is found, regardless of when discovered, to:
have a history of complaints of abuse of a minor;
have resigned, been terminated, or been asked to resign from a position whether paid or unpaid, due to complaint(s) of sexual abuse of a minor; and/or
have falsified or omitted information in this disclosure statement.
This disclosure statement must be updated yearly.
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