Application for Summer Camp Specialist Employment

Background Screening Consent Form

(Required for Florida Level 2 Screening)
The Retreat at Silver Springs – Background Screening Consent

Florida law requires Level 2 background screening, including fingerprinting and state/national criminal history checks, for all camp personnel working with minors. Employment or volunteer service is contingent upon eligibility under Chapters 409.175 and 435, Florida Statutes.
Applicant Full Legal Name
Date of Birth

MonthDayYear
Date
Social Security Number
I understand and agree to the following:
- I consent to fingerprinting and Level 2 background screening.
- I authorize the release of my criminal history records to The Retreat at Silver Springs and its governing organization for
  the purpose of determining my eligibility to work with minors.
- I understand that certain offenses permanently disqualify individuals from working in child‑related settings under Florida
  law.
- I affirm that all information I have provided is true and complete.
- I understand that providing false information may result in disqualification or dismissal.
Checking this box represents your digital signature and authorization.
Printed Name*
Date*

MonthDayYear
Date
Parent/Guardian Printed Name (if applicant is under 18)
Date

MonthDayYear
Date

Safe Environment/Abuse Prevention Acknowledgement

(For compliance with denominational and insurance requirements)
The Retreat at Silver Springs – Safe Environment & Mandatory Reporting Acknowledgment

Because we serve children and youth in a Christian setting, we commit to creating a safe, nurturing
environment for every camper. All staff and volunteers must complete required training and follow all
policies related to child protection.
I acknowledge the following:
- I will complete all required Safe Church/Safe Environment/Abuse Prevention training before
  beginning service.
- I understand that I am a mandatory reporter of suspected abuse or neglect under Florida law.
- I will follow all supervision guidelines, including two‑adult rules, visibility requirements, and
  boundaries for appropriate conduct.
- I will uphold the mission and values of The Retreat at Silver Springs and conduct myself in a manner consistent with Christian leadership.
- I understand that failure to follow these policies may result in immediate dismissal.
Checking this box represents your digital signature and authorization.
Printed Name*
Date*

MonthDayYear
Date
Should be Empty:

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