• Royal Family Kids Camp 2019 Teen Reach Adventure Camp 2019

    Staff or Counselor Application
  • WHAT CAMP OR CAMPS ARE YOU APPLYING FOR 

  • CAMP EXPERIENCE AND QUALIFICATIONS

     


  • APPLICANT INFORMATION

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  • Personal Profile

     

     

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  • Personal References

    No relatives please 

     

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  • Criminal Background

    If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answser yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any future risk of embarrassment upon disclosure.

     

  • Representations and Release

    I understand that RFKC and TRAC 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 RFKC and TRAC are 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 RFKC/TRAC or any other child-serving organization, and seek help.  One option is: "Hope for the Heart" at 1-800-488-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 could 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 or conversations 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 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(s) or RFKC and TRAC leadership, I hereby authorize you to contact any references, churches, youth groups, schools attended, former and present employers, charities, courts, 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 persons, agency or organization 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 RFKC, TRAC, the sponsoring churches, and RFKC and TRAC 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 RFKC and/or TRAC 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 RFKC or TRAC leadership, or me at any time with or without cause.  

    I understand that none of the documents, policies, procedures, actions, statements of RFKC and TRAC, the sponsoring church, the RFKC and TRAC Leaderhip 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 RFKC and TRAC 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 acknoledgement 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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  • Informed Consent and Acknowledgement

    I hereby give my approval for my participation in any and all activities prepared by Royal Family Kids Camp and Teen Reach Advendture Camp during the selected camp(s). In exchange for the acceptance of my candidacy by  Royal Family Kids Camp and Teen Reach Advendture Camp ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Royal Family Kids Camp and Teen Reach Advendture Camp, and the camp grounds where the camps are held . and all its respective officers, agents, and representatives from any and all liability for injuries to myself arising out of traveling to, participating in, or returning from selected camp sessions.

    In case of injury to myself, I hereby waive all claims against Royal Family Kids Camp and Teen Reach Advendture Camp, and the camp grounds where the camps are held . including all directors, staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

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  • Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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  • APPLICANT MEDICAL INFORMATION

  • EMERGENCY CONTACT

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  • Medical Release and Authorization

     In an event I am not able to communicate consent, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of myself in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of my life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

    Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for myself. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to obtain consent from myself and then to contact my emergency contacts in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to recieve my consent or to reach them.

    Permission is also granted to the Royal Family Kids Camp and Teen Reach Advendture Camp, . and its affiliates including Directors, staff, medical profesionals to provide the needed emergency treatment prior to my admission to the medical facility.

    Release authorized on the dates and/or duration of the registered camp(s).

    This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of myself, in the case where I am unable to give consent and my emergency contacts are absent.

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  • State of Illinois Department of Children and Family Services

    AUTHORIZATION FOR BACKGROUND CHECK . Child Abuse and Neglect Tracking System (CANTS)
  • For Programs NOT Licensed by DCFS

    NOTE:   Do not use this form if you are an applicant for licensure or an employee/volunteer of a licensed child care facility.  Please contact your licensing representative

  • I hereby authorize the Illinois Department of Children and Family Services to conduct a search of the Child Abuse and Neglect Tracking system (cants) to determine whether I have been a perpertrator of an indicated incident of child abuse and /or neglect or involved in a pending investigation.  I further consent to the release of this information to the agency listed below

    Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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