THE FOLLOWING INFORMATION WILL BE KEPT CONFIDENTIAL AND ACCESSED AND/OR DISTRIBUTED ONLY AS DEEMED NECESSARY FOR THE SAFETY AND WELL-BEING OF THE CAMPER.

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:

• Child pornography
• Use of a minor in a sexual performance
• Soliciation of a minor, including online soliciation
• Kidnapping and false imprisonment
• Criminal sexual conduct
• Indecent exposure

I understand that:

• The camp may deny volunteer status to any person who answers "yes" to any of the questions represented in this form. If camp leadership later discovers circumstances that would incidate a "yes" answer to any of the above questions, service may been terminated immediately.
• The information provided on this form is subject to verification, which may include a criminal history check and request from a central registry of child abusers.
• The camp may terminate volunteer services 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 of 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 annually.

Laws and Regulations Relating to Organized Camps

30750 Health Supervision
(a) Every camper and each staff member entering camp shall furnish a health history of his or her health status that is completed and signed by the individual camper or staff member, or by the parent or guardian if the camper or staff member is under the age of 18. This history shall be kept on site as long as the camper or staff member is at camp and shall include the following:
(1) A description of any health condition requiring medication, treatment, special restrictions or consideration while at camp.
(2) A record of immunizations including date of last tetanus shot.
(3) A record of any allergies.

ALL MEDICAL INFORMATION WILL BE KEPT CONFIDENTIAL. SIGNING BELOW GIVES PERMISSION TO TRANSMIT THIS INFORMATION ELECTRONICALLY.

This medical history is correct to the best of my knowledge, and I should be able to engage in ALL camp activities except as noted above (or on registration page).