Saturday Camp Miracles Volunteer Form

Thank you for your interest in volunteering at Saturday Camp Miracles! Please complete the form below in its entirety. Once completed, you will be redirected to a submission page with next steps.

Once you complete your next steps, we will receive your clearances and review your form and will notify you if you have been approved to volunteer at Saturday Camp Miracles. We are unable to have you volunteer at Saturday Camp Miracles unless you have been approved. If you have any questions please email us at kathy.whetzel@hopeforkids.org

2025 Federal Disclosure Statement

Required by the Child Protective Service Law 23 Pa. C.S. Section 6344.2 (relating to volunteers having contact with children)

I swear/affirm that I am seeking a volunteer position and AM NOT required to obtain a certification through the Federal Bureau of Investigation (FBI), as the position I am applying for is unpaid; and I have been a resident of Pennsylvania during the entirety of the previous ten-year period. I understand that if I have not been a resident of Pennsylvania during the entirety of the previous ten-year period but have received certification from the FBI since establishing residency, I must provide a copy of the certification to my employer and am not required to obtain any additional FBI certifications.

I swear/affirm that, if providing certifications that have been obtained within the preceding 60 months, I have not been disqualified from service as outlined below or have not been convicted of an offense similar in nature to a crime listed below under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former

law of this Commonwealth.

I swear/affirm that I have not been named as a perpetrator of a founded report of child abuse within the past five (5) years as defined by the Child Protective Services Law

I swear/affirm that I have not been convicted of any of the following crimes under Title 18 of the Pennsylvania consolidated statutes or of offenses similar in nature to those crimes under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth. Chapter 25 (relating to criminal homicide) Section 2702

(relating to aggravated assault) Section 2709.1 (relating to stalking) Section 2901 (relating

to kidnapping) Section 2902 (relating to unlawful restraint)Section 3121 (relating to rape) Section 3122.1 (relating to statutory sexual assault)Section 3123 (relating to involuntary deviate sexual intercourse)Section 3124.1 (relating to sexual assault) Section 3125 (relating to aggravated indecent assault)Section 3126 (relating to indecent assault) Section 3127 (relating to indecent exposure) Section 4302 (relating to incest) Section 4303 (relating to concealing death of child) Section 4304 (relating to endangering welfare of children) Section 4305 (relating to dealing in infant children) Section 5902(b) (relating to prostitution and related offenses)Section 5903(c)(d) (relating to obscene and other sexual material and performances) Section 6301 (relating to corruption of minors) Section 6312 (relating to sexual abuse of children), or an equivalent crime under Federal law or the law of another state.I swear/affirm that I have not been convicted of a felony offense under Act 64-1972 (relating to the controlled substance, drug device and cosmetic act) committed within the past five years. I understand that I shall not be approved for service if I am named as a perpetrator of a founded report of child abuse within the past five (5) years or have been convicted of any of the crimes listed above or of offenses similar in nature to those crimes under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth.

I understand that if I am arrested for or convicted of an offense that would constitute grounds for denying participation in a program, activity or service under the Child Protective Services Law as listed above, or am named as perpetrator in a founded or indicated report, I must provide the administrator or designee with written notice not later than 72 hours after the arrest, conviction or notification that I have been listed as a perpetrator in the Statewide database.

I understand that if the person responsible for employment decisions or the administrator of a program, activity or service has a reasonable belief that I was arrested or convicted for an offense that would constitute grounds for denying participation in a program, activity or service under the Child Protective Services Law, or was named as perpetrator in a founded or indicated report, or I have provided notice as required under this section, the person responsible for employment decisions or administrator of a program, activity or service shall immediately require me to submit current certifications obtained through the Department of Human Services, the Pennsylvania State Police, and the Federal Bureau of Investigation, as appropriate. The cost of certifications shall be borne by the employing entity or program, activity or service;  I understand that if I willfully fail to disclose information required above, I commit a misdemeanor of the third degree and shall be subject to discipline up to and including denial of a volunteer position;

I understand that certifications obtained for the volunteering purposes can only be used for that purpose and cannot be used for employment purposes.

I understand that the person responsible for employment decisions or the administrator of a program, activity or service is required to maintain a copy of my certifications.

I hereby swear/affirm that the information as set forth above is true and correct. I understand that false swearing is a misdemeanor pursuant to Section 4903 of the Crimes Code

ODAAT Volunteer Affirmation

I swear and affirm that I am not disqualified from service pursuant to section 6344(c) or have not been convicted of an offense similar in nature to those crimes listed in section 6344(c) under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth.

Title 23 Section 6344(c): Grounds for denying employment or participation in program, activity or service.

(1) In no case shall an administrator hire or approve an applicant where the department has verified that the applicant is named in the Statewide database as the perpetrator of a founded report committed within the five-year period immediately preceding verification pursuant to this section.

(2) In no case shall an administrator hire an applicant if the applicant's criminal history record information indicates the applicant has been convicted of one or more of the following offenses under Title 18 (relating to crimes and offenses) or an equivalent crime under Federal law or the law of another state:

  Chapter 25 (relating to criminal homicide).
  Section 2702 (relating to aggravated assault).
  Section 2709.1 (relating to stalking).
  Section 2901 (relating to kidnapping).
  Section 2902 (relating to unlawful restraint).
  Section 3121 (relating to rape).
  Section 3122.1 (relating to statutory sexual assault).
  Section 3123 (relating to involuntary deviate sexual intercourse).
  Section 3124.1 (relating to sexual assault).
  Section 3125 (relating to aggravated indecent assault).
  Section 3126 (relating to indecent assault).
  Section 3127 (relating to indecent exposure).
  Section 4302 (relating to incest).
  Section 4303 (relating to concealing death of child).
  Section 4304 (relating to endangering welfare of children).
  Section 4305 (relating to dealing in infant children).
  A felony offense under section 5902(b) (relating to prostitution and related offenses).
  Section 5903(c) or (d) (relating to obscene and other sexual materials and performances).
  Section 6301 (relating to corruption of minors).
  Section 6312 (relating to sexual abuse of children).
  The attempt, solicitation or conspiracy to commit any of the offenses set forth in this paragraph.

(3) In no case shall an employer, administrator, supervisor or other person responsible for employment decisions hire or approve an applicant if the applicant's criminal history record information indicates the applicant has been convicted of a felony offense under the act of April 14, 1972 (P.L.233, No.64), known as The Controlled Substance, Drug, Device and Cosmetic Act, committed within the five-year period immediately preceding verification under this section.

HOPE FOR KIDS VOLUNTARY DISCLOSURE

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 or 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.

I understand that:
a) The camp may deny employment or volunteer opportunity to any person who answers “yes” to any one of questions 2-6. If hired or volunteering,and the employer later discovers circumstances that would indicate a “yes” answer to any of the above questions, employment may beterminated immediately.
b) The information provided on this form is subject to verification, which may include a criminal history check and request from any Central Registryof child abusers.
c) The camp may terminate employment or volunteer service of any person if that person is found, regardless of when discovered, to:
1) have a history of complaints of abuse of a minor;
2) have resigned, been terminated, or been asked to resign from a position whether paid or unpaid, due to complaint(s) of sexual abuse of aminor; and/or
3) have falsified or omitted information in this disclosure statement.
d) By Pennsylvania state law I am a mandated reporter and am legally required to report any suspicion of abuse or neglect of any minor to Pennsylvania’s ChildLine Hotline at 1-800-932-0313.e) This disclosure statement must be updated yearly.