Returning Camp Staff 2019
July 1st-5th, 2019
Street Address Line 2
State / Province
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Driver's License Number
Social Security Number
Applying for Position
If asking to be a Big Camper, what age would you prefer your campers?
Number of Years at current occupation
Emergency Contact Number
Do you have any of the following?
Have you worked with orassociated with abused, neglected or abandoned children this past year?
If yes, in what way?
Why would you like to return to camp this year?
Please list any medical problems that you have that we would need to know of at camp.
Please list any medications that you take.
Please list any serious injuries or illnesses since last camp.
If you were abused, neglected or abandoned as a child, how did that affect you at camp?
Please describe your spiritual growth since camp last year.
How has RFK camp made an impact on your life?
From your experience, what would you suggest to a new staff member coming for the first time?
Can you name a staff or counselor that was a great help to you? In what way?
How has your family responded to you being involved with RFK?
What current ministries or activities are you involved with at your church?
What new strengths and weaknesses have you discovered since working with abused kids?
If your records have been expunged pursuant toapplicable 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 answeryes and fully disclose all incidents to avoid any future risk of embarrassmentupon disclosure.
Have you ever been convicted of or pleaded guilty to any crimes (includingcrimes of record which have been expunged and pleas of 'no contest'), includingmunicipal,state and federal?
Have you ever been placed on probation, received a Suspended Execution, Suspended Sentence or Suspended Imposition of Sentence for any offense involving a minor child (a child under 18), or been placed on ANY local, state, or federal sexual registry?
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?
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?
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?
Representations and Release
I understand that RFK maintains strict policies against any form of child abuse, and that violation of these policies may because 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) because 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 duration and 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.
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