Volunteer/Employee Disclosure Form All Adult Volunteers (including pastors, counselors, day-helpers) and Employees of Grace XP Youth Camp are required to fill out this form. Note -by filling out and signing the form below, you authorize Grace XP Camp and its cooperating churches to perform a criminal background check on you. Name Main telephone Address Age range17 or younger18-2526 or older Church Name T-Shirt size (Adult sizes) SMLXLXXLXXXL Have you at any time ever been arrested for any reason?YesNo Have you been convicted of, plead guilty, no contest to any crime?YesNo Have you engaged in, or been accused of, any child molestation, exploitation, or abuse?YesNo Are you aware of having any traits or tendencies that could pose any threat to children, youth or others?YesNo Is there any reason why you should not work with children, youth or others?YesNo If the answer to any of these questions is "yes," please explain in detail. -I recognize that Grace XP Youth Camp is relying on the accuracy of the information I provide on the Volunteer/Worker Disclosure Form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct. I authorize the organization and its cooperating churches to contact any person or entity deemed necessary to collaborate the information provided on this form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications. I agree to protect the health and safety of the children or youth assigned to my care or supervision at all times. Email address Signature(Please read this document carefully before you sign)