Child Protection & Staff Boundaries Policy Acknowledgment
Please confirm your understanding and acceptance of the Mass Mambo Kids Child Protection & Staff Boundaries Policy by completing this acknowledgment form.
Employee/Volunteer Full Name
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First Name
Last Name
Position/Role
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I have received and reviewed the Mass Mambo Kids Child Protection & Staff Boundaries Policy.
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Acknowledge
I understand my responsibility to maintain appropriate boundaries with children and adolescents participating in Mass Mambo Kids programs.
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Acknowledge
I understand that violations of this policy may result in removal from duties, termination of employment or volunteer service, and/or referral to appropriate authorities.
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Acknowledge
I understand my responsibility to immediately address and report child-safety concerns in accordance with Mass Mambo Kids policies and applicable law.
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Acknowledge
Employee/Volunteer Signature
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Employee/Volunteer Signature Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Mass Mambo Kids Representative Full Name
First Name
Last Name
Mass Mambo Kids Representative Signature
Mass Mambo Kids Representative Signature Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: