Volunteer Staff Application

Have you ever been arrested. plead no contest, and/or been convicted of any crime? *

Yes no

Has anyone ever taken or threatened to take adverse employment action against you for reasons relating to allegations of physical or sexual abuse or sexual harassment. *

Yes No

Has an employer ever taken or threatened to take adverse employment action against you for reasons relating to allegations of physical or sexual abuse or sexual harassment. *

Yes No

Have you ever been accused of , participated in , or been convicted of child sexual abuse? *

Yes No

If selected to be a camp counselor, I agree to abide by the Bylows and policies of the American Baptist Churches of Akron, Ashtabula, and Cleveland and the Camping Ministry at Koinonia. I also give Koinonia Camp permission to take and use pictures and videos for promotional purposes.

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have reguarding my character and fitness for service with children, youth or vulnerable populations.

I voluntarily release the organization and any such person or entity listed herin from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation if such a check is deemed necessary.
I have read and understand the contents of this application and the Volunteer Staff Handbook and sign it of my own free will.

Please list three persons (besides the pastor or your family members) who could speak to your qualifications and abilities to be a camp counselor:

Please enter any additional information you would like to share with us in the space below.

emergency medical form for volunteers

Emergency Contact Name *

First

Last

List any current medical condition including severe allergies (i.e. heart problems, high blood pressure, asthma,etc.) *

Emergency Contact Phone Number *

Volunteer Staff Application

background Information

emergency medical form for volunteers