Volunteer Application
Volunteer application and Voluntary Disclosure to allow for a background check.  PLEASE READ EVERY QUESTION CAREFULLY TO BE SURE YOU ARE PROVIDING ALL THE INFORMATION REQUESTED.
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Email *
Volunteers must be at least 15 years old to work at camp. Do you meet these requirements? *
Full Name (first, middle, last)
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COMPLETE Mailing Address (street, city, state, zip code)
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Best Phone number to reach you?
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Parent/Guardian Name(s) First & Last (if under 18)
Parent/Guardian Phone numbers - home and cell phones (If under 18)
Parent/Guardian full address (street, city, state, zip code) (If under 18)
What size T-shirt/Sweatshirt? (example: L/XL) *
How did you hear about Camp Millhouse? *
What type of volunteer work work would you like to do? *
Do you have any experience working with people with special needs? If so, what age group? *
Why do you want to volunteer at Camp Millhouse? *
How would you describe yourself to someone who doesn't know you? *
Do you have any special skills? *
What days/times are you available to volunteer? *
Do you need documentation of your volunteer hours? *
VOLUNTARY DISCLOSURE STATEMENT FOR ALL CAMP STAFF AND VOLUNTEERS.  The following questions allow Camp to run a full background check which is a condition to employment at Camp Millhouse.
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Full Name - first, middle and last
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Birthdate *
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COMPLETE Mailing Address (street, city, state, zip code)
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Social Security number?  If you prefer to give this over the phone, you need to call the office  when done with this form (574-233-2202) and fill in the answer as 111-22-3333
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Other names by which you are known (i.e. maiden name).  If none, please type none.
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Please provide both cell phone and home phone numbers (designate cell versus home)
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Email *
Name of school/college along with full address.  If none, type none
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Driver's License number, what state issued from, expiration date?  Example:  1234-56-7890, IN, 1/1/21
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1.  Any previous residence(s) for last three years (include college and home residences):  just list City, State and Year.  Example: Sacramento, CA 1999-2009
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2.  Have you ever been convicted of any crime relating in any manner to children or adults and/or your conduct with them?
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If yes to question #2, please explain.  If no, type N/A
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3. Have you ever been convicted of any crime including, but not limited to, those listed below and/or any crime similar in any manner to those listed here?  A. Indecent assault and battery on a child under fourteen;  B. Indecent assault and battery on any person with physical or intellectual disabilities C. Indecent assault and bettery on a person who has obtained the age of fourteen;  D. Rape;  E. Rape of a child under sixteen with force;  F. Assault with intent to commit rate;  G. Kidnapping of a child under sixteen with intent to commit rape;  H. Distribution and trafficking of narcotics or other controlled substances;  I. Intent to commit any of the above crimes.
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If yes to question #3, please explain.  If no, type N/A
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4.  Has there ever been a civil judgment against you involving sexual and/or physical abuse?
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If yes to question #4, please explain.  If no, type N/A
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5.  Are you now or have you ever been part of a federal, state, or court ordered registry involving sexual or physical abuse of any minor or adult?  
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If yes to question #5, please explain.  If no, type N/A
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I understand that:  A) The camp may deny employment to any person who answers “yes” to any one of questions 2-6. 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.   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; 2)have resigned, been terminated, or been asked to resign from a position whether paid or unpaid, due to complaint(s) of sexual abuse; and/or 3)have falsified or omitted information in this disclosure statement. and  D) This disclosure statement must be updated yearly.
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Typing your name here serves as your legal signature of this form
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Today's date *
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Minor’s Parent or Guardian - typing your name here serves as your legal signature of this form.  If you are 18 or over, you do not require parent/guardian signature so just type "N/A"
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Date of Parent/Guardian signature if signature required
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