Adult Leader Voluntary Disclosure Form

Rainbow Trail Lutheran Camp believes that it is critical to provide a safe place for all campers and staff to grow in, and share their faith.  For years the camp has operated with the “Sexual Misconduct Policy of Rainbow Trail Lutheran Camp”.  This Board approved policy lays out the framework for interactions between campers, staff, and adults at Rainbow Trail.  Rainbow Trail currently obtains a voluntary disclosure statement and background checks for all employees.  After our annual review of policies, it has been decided to expand this process to include all adults participating in any RTLC program.  The Sexual Misconduct Policy and Voluntary Disclosure Form are available below.  Rainbow Trail will conduct background checks through the National Sex Offender Public Website. If you are an adult participating in a Rainbow Trail Lutheran Camp program, please:

  1. Read the Sexual Misconduct Policy (click here) of Rainbow Trail Lutheran Camp
  2. Fill out and submit the Adult Voluntary Disclosure Form  below:

Full Legal Name

Year of Birth

Address

City, State, Zip

Preferred Phone

E-mail

Church Name

City, State

Program Participating In: (required)
 RTLC Senior High Retreat Confirmation Retreat Bridging Borders Compass Points Onsite

Program Dates (required)
 RTLC Senior High Retreat Confirmation Retreat Week 1: June 11-17 Week 2: June 18-24 Week 3: June 25-July 1 Week 4: July 2-8 Week 5: July 9-15 Week 6: July 16-22 Week 7: July 23-29 Week 8: July 30-August 5 Week 9: August 6-12 Week 10: August 13-19

All staff and adult leaders at RTLC are required to wear a name tag. These will be provided for you. What name would you like to have on your name tag?

I have read, understand, and agree to abide by the Sexual Misconduct Policy of
Rainbow Trail Lutheran Camp?
 Yes No

Have you ever been accused of the commission of an act of child abuse or unlawful sexual offense? (A prior accusation is not an automatic bar to participating in a Rainbow Trail Lutheran Camp sponsored program with your congregation. The type of accusation and when it occurred will be evaluated by the camp before any decision is made.)
 No Yes

If "Yes," please explain:

The above statements are true and complete to the best of my knowledge. Any falsification, misrepresentation, or incompleteness in this disclosure is alone grounds for disqualification or dismissal. The information that I have provided may be verified, if necessary by contacting persons or organizations named in this application.

I hereby waive any and all rights and claims that I might have regarding Rainbow Trail Lutheran Camp, it's employees, owners, officers, directors, and agents for seeking, gathering and using truthful and non-defamatory information in a lawful manner, in the employment process and all other persons entities or organizations for furnishing such information about me.

I also give permission for the use of photographs, video, and electronic images of me in camp materials and publicity.

By typing by name below I acknowledge that I personally completed this form truthfully and I agree that my typed name is the same as my valid legal written signature.

Signature

Date

Any applicant who knowingly or willfully makes a false statement of any material fact or thing in this application is guilty of perjury in the second degree as defined in section 18-8-503, Colorado Revised Statues, and, upon conviction thereof shall be punished accordingly.