Sponsored by Activate Church
June 15-21, 2024
Returning Counselor / Staff Application
All information is held strictly confidential. This form must be completely filled out. The information is vital to your acceptance and impossible placement as a volunteer.
Date
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Month
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Day
Year
Date
Name
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First Name
Last Name
Upload a photo of your Driver’s License or Identification Card
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Browse Files
Cancel
of
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
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Number of years
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Home Phone
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Area Code
Phone Number
Cell Phone
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Area Code
Phone Number
Email
example@example.com
Preferred method of contact:
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Cell
Home
Email
Emergency Contact
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Name of Person
Phone Number
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Area Code
Phone Number
Relationship
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T-shirt Size
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Small
Medium
Large
XL
XXL
XXXL
Have you received certification in the following?
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CPR
First AId
Life Guard
Nurse
EMT
None
Have you worked with or associated with abused, neglected or abandoned children this past year?
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Yes
No
In what way?
Please describe why you wish to return as a counselor/staff for abused children.
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Medical History
Have you had any medical problems?
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Yes
No
Please explain:
Do you take any medication?
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Yes
No
Please list any medications and side effects
Have you had any serious injuries or illnesses since last camp?
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Yes
No
Please explain:
Personal Growth
If you were abused or neglected as a child, how did that affect you at camp?
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Please describe you spiritual growth since you have been a Royal Family KIDS Camp counselor/ staff.
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How has Royal Family KIDS camp made an impact on your life?
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From you experience, what would you suggest to a new counselor/staff coming for the first time?
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Can you name a counselor or staff member that was a great help to you? In what way?
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How has your family responded to your involvement with Royal Family Kids?
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What current ministries or activities are you involved with at your church?
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What new strengths have you discovered since working with abused kids?
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What new weaknesses have you discovered since working with abused kids?
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What position do you prefer?
Counselor
Staff
This year, if a counselor, I would prefer my campers to be:
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6-7
7-8
8-9
9-10
10-11
11-12
Staff
List any suggestions you think would make camp better for the kids, counselors or staff.
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Criminal Background
If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any future risk of embarrassment upon disclosure.
1. Have you ever been convicted of or pleaded guilty to any crimes (including crimes of record which have been expunged and pleas of 'no contest'), including municipal, state and federal?
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Yes
No
2. Have you ever been placed on probation, received a Suspended Execution, Suspended Sentence orSuspended Imposition of Sentence for any offense involving a minor child (a child under 18), or beenplaced on ANY local, state, or federal sexual registry?
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Yes
No
3. Have you ever been sued in a civil court of law where the allegations in the suit involved illegal, inappropriate, or sexual conduct or contact with a minor child?
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Yes
No
4. Have you ever been subject to any court order involving any sexual, physical or verbal abuse including but not limited to any domestic violence or civil harassment injunction or protective order?
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Yes
No
5. Have you ever resigned, been terminated or been asked to resign from a position, whether paid or as a volunteer, due to a complaint(s) of sexual, physical or verbal abuse of minors?
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Yes
No
REPRESENTATIONS AND RELEASE
I understand that RFK maintains strict policies against any form of child abuse, and that violation of these policies may be cause for dismissal. Child abuse is punishable by law, and RFK is bound by law to report allegations of abuse or any inappropriate sexual contact to the proper authorities. ALL reporting is kept confidential, by law. All volunteers must commit to immediately report any behavior that seems suspicious, questionable, abusive or inappropriate between: child-to-child, staff-to-child, and staff-to-staff.If YOU are struggling with a sexual attraction to children, please opt out of service in RFK or any other child- serving organization, and seek help. One option is: “Hope for the Heart” at (800) 488-HOPE (4673) or www.hopefortheheart.org.I understand that I will be required to submit to a background check as a condition of acceptance as a volunteer, and that unsatisfactory results, refusal to cooperate, or any attempt to affect the results of these background checks will result in me being removed as a volunteer or volunteer applicant.I hereby certify that all of the information provided by me in this Application (or in any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in these documents may (or will) be cause for the denial of acceptance as a volunteer, or immediate removal as a volunteer, regardless of the timing or circumstances of discovery.In consideration of the receipt and evaluation of this Application by the sponsoring Church or RFK Camp Leadership, I hereby authorize you to contact any references, churches, youth groups, schools attended, former and present employers, charities, courts, and any other person, agency, or organization that may have information about me, and for them to provide to you such information (including opinions) that they may have regarding my character and fitness for working with children; I hereby release any such references, churches, youth groups, schools attended, former and present employers, charities, courts, and any other person, agency or organization who may have provided information about me, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I also agree to hold RFK, the sponsoring church and RFK Camp Leadership harmless from any damages created by my unwarranted attempt to collect damages for providing information described above. I waive any right that I may have to inspect any information provided about me or by any person or organization identified by me in the Application process.I understand that submission of an application does not guarantee me acceptance as a volunteer. I further understand that should the RFK Leadership extend an offer to me as a volunteer, it is for no specific durationand may be revoked by either the sponsoring church, the RFK Camp Leadership, or me at any time, with or without cause.I understand that none of the documents, policies, procedures, actions, statements of RFK, the sponsoring church, the RFK Leadership or their representatives and agents used during the volunteer application process is deemed a contract, real or implied. If accepted as a volunteer, I agree to conform to the rules, regulations, policies, and procedures of RFK while serving as a volunteer, and understand that such compliance is a condition of remaining a volunteer.I have carefully read the above Application and this Acknowledgement and Release, and know and understand its contents; I also know the above is a legally binding agreement. I sign this Application and Release of my own free will.By signing my name, I hereby signify the above information is true and correct to the best of my knowledge.
Name
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First Name
Last Name
Signature
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Date
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Month
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Day
Year
Date
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