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For Office Use Only ______Received ______Interviewed ______Contacted Attach copy of Driver’s ______Background ck License

All Volunteer Training Sunday 7/30 Training

Sponsored by: Community of Hope Lutheran Church Monday, July 31st – Friday, August 4th, 2017 Return completed applications to: Wilsonville RFK, PO Box 1433 Sherwood OR 97140

R ETURNING STAFF APPLICATION

Instructions: All information is held strictly confidential. This information is vital to your acceptance and placement as a staff at our 2017 Royal Family KIDS Camp. This application must be completely filled out and legible.

VOLUNTEER INFORMATION: Last Name: First Name: Today’s Date:

Birthdate: Current Age: Sex: Marital Status: M F Single Married Divorced Widowed Street Address: City: State: Zip Code:

Home Phone: Other Phone: Email:

Occupation: Employer: Number of years:

T-Shirt Size: Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Do you have certification in any of the following? CPR First Aid Lifeguard Nurse EMT Other: Desired position(s) at 2017 Royal Family KIDS Camp: Counselor Breakfast Club Birthday Party Relief Counselor Drama Registration Aunt/Uncle Afternoon Activities Photography Grandma/Grandpa Evening Activities I work best with campers who are: 7 years old 8 years old 9 years old 10 years old 11 years old

EMERGENCY CONTACT: Name: Relationship: Phone:

PERSONAL GROWTH:

Have you worked with or associated with abused, neglected or abandoned children this past year? No Yes, please describe:

Please describe why you wish to return as a volunteer at the 2017 Royal Family KIDS Camp: .

If you personally have experienced abuse, neglect or abandonment, how did that affect you at camp? .

How has Royal Family KIDS Camp made an impact on your life? .

Please describe your spiritual growth since you have been at Royal Family KIDS Camp: .

From your experience, what advice would you give to a first-time volunteer? .

Can you name a staff that was a great help to you? What was so helpful? .

How has your family responded to you being involved with Royal Family KIDS? .

What current ministries or activities are you involved with at your church? .

. . What new strengths and weaknesses have you discovered since working with children of abuse? (please be specific) Strengths: 1. 2. 3. Weaknesses: 1. 2. 3. MEDICAL HISTORY:

Do you have any medical conditions? No Yes, please describe: .

Do you take any medications? No Yes, please list medications, reason and any side effects: .

Have you had any serious illness or injuries in the last three years? No Yes, please describe: .

. Do you have any physical handicaps or conditions preventing you from performing any type of activity? No Yes, please describe: . .

APPLICANT’S STATEMENT: The information contained in this application is correct to the best of my knowledge. In consideration of the receipt and evaluation of this application by Wilsonville Royal Family KIDS/Community of Hope, ELCA, I hereby release any individual, church, youth organization, charity, employer reference, or any other person or organization, 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 waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.

I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand.

Printed Name Signature Date

REQUEST FOR CRIMINAL BACKGROUND CHECK: To protect the safety and welfare of children, Wilsonville Royal Family KIDS/Community of Hope, ELCA conducts criminal history background checks on all volunteers. Our background checks are run through a secure company and all personal information will be handled confidentially. Legal First Name: Legal Middle Name: Legal Last Name:

Maiden/Birth Name or Any Other Names You Have Used:

Street Address: City: State: Zip Code:

Have you lived outside the State of Oregon in the last year? If so please list previous address(es) below:

Date of Birth: Social Security Number: Driver’s License Number: Issuing State:

Have you ever been arrested or convicted of a crime involving a child(ren)? No Yes Have you ever been arrested or convicted of a sex-related crime? No Yes Have you ever been arrested or convicted of a crime involving violence or threat of violence? No Yes Have you ever been arrested or convicted of a crime involving criminal activity in drugs or alcoholic beverages? No Yes Have you ever been arrested or convicted of any other crime except a minor traffic violation? No Yes Have you been arrested within the last three years for a crime in which there has not yet been an acquittal or No Yes dismissal? If you answered “YES” to any of the above please explain.

By my signature below, I certify that the facts and information contained in this background application are true and complete to the best of my knowledge. I understand that any omission and/or falsely answered statements made by me on this background application shall be grounds for denial to volunteer with Wilsonville Royal Family KIDS/Community of Hope, ELCA. Furthermore, I hereby grant Wilsonville Royal Family KIDS/Community of Hope, ELCA permission to check civil or criminal records to verify any statement made on this form. The applicant is entitled to review his/her criminal history for inaccurate or incomplete information.

Printed Name Signature Date