Camp Volunteer App & Background Check Disclosure

Camp Staff & Volunteer Application & Background Check Disclosure
Youth & Family Ministry

Thank you for your heart and interest in serving the Youth & Family Ministry (YFM) as a Camp Volunteer. With your help, we can strengthen the entire church by edifying the Youth and Family Ministry.

Please fill out the following information and submit the form. We will let you know when and if you are selected to serve in this way.

First Name*

Middle Name

Last Name*

Age

Camp Information

Kids CampMiddle School CampHigh School CampOther

Kids Camp Dates

Youth Camp Dates

What Role are you interested in?

Write a paragraph explaining why you would like to serve at the Youth & Family Ministry Camp:

Personal Information

Cell Phone Number*

Format: (000) 000-0000.

Work Phone Number

Format: (000) 000-0000.

Home Phone Number

Format: (000) 000-0000.

Email*

Full Address

Current Address

Street Address

Street Address Line 2

CityState

Zip Code

Gender*

Birthdate*

Date

T-Shirt Size

Your Church / Region*

Your Community Group*

How long have you been a disciple of Jesus?*

Baptism Date

Medical Information

Enter any medical conditions you have that we should be aware of

Enter any allergies and food restrictions you have that we should be aware of

YesNo

Prescription Medications

You will need to check in any prescription medications at check-in, to protect campers from possibly getting to them.

List all prescription medications you will have at camp.

Medication 1

Dose 1

Time of Day 1

Reason 1

Medication 2

Dose 2

Time of Day 2

Reason 2

Medication 3

Dose 3

Time of Day 3

Reason 3

Insurance

Ponderosa Camp requires this information.

Insurance Company*

Policy #*

Group #*

Insurance Phone Number*

Format: (000) 000-0000.

Terms & Conditions

Please read the following Terms & Conditions and check "I agree" or "I do NOT agree".

Emergency Terms & Conditions

Should it be necessary for the Camper to receive emergency medical attention or treatment while participating in Camp Activities, I hereby give permission for the person(s) leading or directing the Camp Activities (the “Camp Directors”), to render medical attention or administer emergency medical treatment (i.e., first aid, CPR, etc.) or secure the services of an ambulance, hospital, physician, or other medical professional to treat the Camper as the Camp Directors deem appropriate and necessary. I understand that financial responsibility for any medical or hospital costs shall be my responsibility.

I agreeI do NOT agree

Participation Terms & Conditions

I acknowledge that participation in the Camp Activities involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the Camp Activities, the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from Camp. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from Camp, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from Camp, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

I agreeI do NOT agree

Photo and Audio Visual Terms & Conditions

I hereby grant Denver Church of Christ, its representatives and employees, including the Youth & Family Ministers and Camp Volunteers, the right to take photographs and multimedia of you and your property, in relation to the 2043 Youth Camps. I also authorize the Church to use such images with or without the Camper's name, and for any lawful purpose including but not limited to publicity, print advertising, and Web content.

I agreeI do NOT agree

Mandatory Reporting Terms & Conditions

I understand that the staff, volunteers, and all those associated with the Rocky Mountain Youth Camps are required by law to report any suspicion of sexual or physical abuse to the appropriate authorities.

This is the Child Abuse Reporting section of the Denver Church of Christ Policies & Procedures:

Section 3.2.1 - Child Abuse Reporting Guidelines
Clergy is defined as "the group or body of ordained persons in a religion, as distinguished from the laity.”

Colorado state law indicates that:
• A report is required when a mandatory reporter has reasonable cause to know or suspect that a child has been subjected to abuse or neglect or has observed the child being subjected to circumstances or conditions that would reasonably result in abuse or neglect.
• Individuals or institutions in Colorado who report suspected child abuse and/or neglect “shall be immune from any liability, civil or criminal, or termination of employment that otherwise might result by reason of such acts of participation, unless a court of competent jurisdiction determines that such person’s behavior was willful, wanton, and malicious” if they report in “good faith,” which means they have not reported recklessly or with no reasonable basis for making a report.

Colorado state law indicates that good faith is presumed unless challenged by the person claiming the report was not made in good faith. Making a child abuse and/or neglect report is your evidence that you fulfilled your mandate to report.

Source: C.R.S. 19-3-304 and C.R.S. 19-3-309

Please note, if you call in a report "Every time you make a call, you should request - and write down - a hotline ID number. As a mandatory reporter with a legal requirement to report concerns about child abuse or neglect, you can use the hotline ID as documentation for the call."

How do I report my concerns? If it is an emergency, call 911. They can ensure the immediate safety of a child and get medical attention if needed. If it is not an emergency, call 844-CO-4-KIDS (844-264-5437).

Visit Mandated Reporting Training, Colorado Child Abuse and Neglect Hotline and CO-4-Kids Mandatory Reporting for more information and valuable resources.

I agreeI do NOT agree

Recreational Activity Release and Waiver Form

The information you have entered in this Application will be used to populate the Release and Waiver Form. (No more hassle with downloading it and sending it back to the office!)

Read the Release and Waiver information on the PDF below. Your signature below will be applied to your Release & Waiver Form.

(The Release and Waiver information is the same on the Kids Camp form).

I agreeI do NOT agree

Background Check Disclosure

The Denver Church of Christ procures a background screening for anyone choosing to serve the Youth & Family Ministry in any role. If information from the report is utilized in whole or in part in making an adverse decision about you serving as a Camp Counselor and upon your request, we will provide you with a copy of the background screening. Please be advised that you have the right to request, in writing, that we make a complete and accurate disclosure of the nature and scope of the information requested.

Please answer the following questions. If any are "Yes", the Youth & Family Ministry leaders will discuss it with you prior to deciding.

YesNo

Enter the last 4 digits of your Social Security Number. For security reasons, we will call you for the full account number.*

Social Security Number will not appear in any email associated with this form. It will be stored in a PCI DCC Compliant database.

Is there anything else you would like us to know?

Do you have current automobile liability insurance?

Driver License State

Street Address

Street Address Line 2

Driver License Number

YesNo

What are the Restrictions?

Upload a copy of Proof of Insurance (front)

Browse Files

Upload a copy of Proof of Insurance (back)

Browse Files

By your signature, you hereby authorize the Denver Church of Christ to obtain a background / investigative screen about you.

Signature:*

Date:*

If we have already run a background check on you in the last few years, you will not need to submit another one at this time.

If you do need a background check, you will receive an email from Checkr. Be on the lookout for this email, and respond promtly as the invitation is only active for a couple days.

We need you to fill this out as soon as possible! You will answer a few questions and submit the form to complete your background check process.