RFK Returning Camp / Staff Volunteer Application

Sponsoring Church's Name:

Camp Dates: Sunday, June 23 - Friday, June 28, 2019

Full Legal Name *

First Name Middle Name Last Name

Choose one: *

This is my first time to serve at a Royal Family KIDS Camp I am a returning Staff or Camp Counselor I have served at RFK Camps in other Cities or States

Current Drivers License Number (A photocopy of license must accompany application) *

Upload picture of your DL here:

Please also upload a current photo of yourself (headshot).

Gender

Male Female

Current Age *

Marital Status *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Confirmation Email

Phone Number: Best one to contact you *

Area Code Phone Number

Occupation *

Name of Employer *

Number of Years At current employer *

Emergency Contact *

Relationship *

Phone (Emergency Contact) *

T-Shirt Size

Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large

Have you received certification in any of the following?

CPR First Aid Life Guard Nurse EMT Counseling or Therapy

Do you have previous background or training in working with children who have been abused or neglected?

Yes No

If yes, in what way?

Were you a victim of abuse, neglect, or abandonment as a minor?

Yes No Yes, but I would prefer to discuss this in person

If yes, please clarify

Please describe why you wish to be a part of Royal Family KIDS Camp and work with children of abuse, neglect, and abandonment

Do you have any medical, emotional, or mental health conditions?

Yes No

Please describe condition(s):

Do you take any medications?

Yes No

Please list medication, reason and any side effects:

Have you had any serious illness, injuries, or medical operations in the last three years?

Yes No

Please list illness or operations:

Have you had any physical handicaps or conditions preventing you from performing any type of activity?

Yes No

Please list conditions:

Have you taken drugs other than prescribed mediations?

Yes No

Please explain:

1) Have you ever been convicted of or pleaded guilty to any crimes (including crimes of record which have been expunged and pleas of 'no contest'), including municipal, state and federal? *

No Yes

2) 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? *

No Yes

3) 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? *

No Yes

4) 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? *

No Yes

5) 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? *

No Yes

If yes to any above, please explain: *

High School Name

Date of Graduation

College

College Major

Date of Graduation

Other Education

Reference #1 - Name

First Name Last Name

Reference #1 - Phone

Area Code Phone Number

Reference #1 - Email

Confirmation Email

Reference #2 - Name

First Name Last Name

Reference #2 - Phone

Area Code Phone Number

Reference #2 - Email

Confirmation Email

Reference #3 - Name

First Name Last Name

Reference #3 - Phone

Area Code Phone Number

Reference #3 - Email

Confirmation Email

Have you committed your life to Jesus Christ?

No Yes

Where & When:

What church do you presently attend? *

For how long?

Pastor's Name *

Have you completed all 4 weeks of Bethel Church's Volunteer-Required Course, Grow track? *

Yes Not yet, I am in progress No

Please describe any previous experience working with children: *

Please describe any previous experience working with children who have been abused or neglected: *

Do you feel you could lead a 15-minute devotion with your campers with materials we provide?

No Yes

List five (5) strengths you have in working with children: Please be specific *

List five (5) weaknesses you have in working with children: Please be specific *

Following Rules: How well do you follow rules and respond to authority

	1	2	3	4	5
Very Well						Poorly

How do you feel you would be best utilized at camp?

I would prefer my campers to be:

7 years old 8 years old 9 years old 10 years old 11 years old

MENTORING CLUB VOLUNTEER ROLES (Check all roles that may be of interest):

MENTOR: Individually matched with a camper for an 8-month commitment (4 hours a month; flexible scheduling and once a month Club meeting). All Club mentors must complete camp training (10+ hours) as well as Club training (5+ hours) and fingerprint-based national criminal background check to be to be eligible to mentor. CLUB STAFF: Once a month Club meeting plus planning (Music, Activities, Refreshments, Bible Story, Puppets, etc.) for an 8-month Club year. All staff must must complete camp training (10+ hours) as well as Club training (5+ hours) and fingerprint-based national criminal background check to be eligible to serve.

DESIGNED FOR: Children (ages 7-11) who attend RFK Camp this summer.

WHEN: Mentors meet with their matched kid about an hour a week or 4 hours a month (flexible scheduling) plus everyone meets once a month for Club time (staff organizes programs). Clubs typically meet September - April.

TRANSPORTATION: Certfied drivers provide transportation as needed (caregivers provide medical and transportation permission for the year). Driver's License and Proof of Insurance required.

VOLUNTEER ROLES (Check any and all roles that may be of interest):

REPRESENTATIONS AND RELEASE
I understand that RFK maintains strict policies against any form of child abuse, and that violation of these policies may be cause 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) be cause 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.

Signature *

Please email rfkc@bethel.org should you have questions regard Royal Family KIDS Camp or the returning volunteer application.

Returning Camp Volunteer Application

Medical History

Criminal Background

Education

Personal References* (required for first time volunteers only) No former employers or relatives.

Personal Profile

Royal Family KIDS Mentoring Club Interest

Thank you for your interest in being a part of the RFK Team!