Voluntary Disclosure Statement (18+)

  • 1. Previous residence(s) for last five years (include college and home residences):

  • 2.

  • 3.

  • 4.

  • 5.

  • 6.

  • 7.

  • I understand that:
    a) The camp may deny employment to any person who answers "yes" to any one of questions 2-7. If hired and the employer later discovers circumstances that would indicate a “yes” answer to any of the above questions, employment may be terminated immediately.
    b) The information provided on this form is subject to verification, which may include a criminal history check and request from any Central Registry of child abusers. (A separate release form may be required)
    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 a minor; and/or
    3) have falsified or omitted information in this disclosure statement.
    d) This disclosure statement must be updated yearly and immediate notification provided to the camp if any information provided changes.

  • Should be Empty:
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