As the person completing this staff application, I hereby certify that the application information provided on this form is current, true and correct to the best of my knowledge. I hereby authorize the contact of any references, and I authorize Kay's Kamp to conduct a criminal background check on myself. I understand that the misrepresentation or omission of information requested is just cause for non-appointment, termination, or disengagement as a volunteer. If accepted as a volunteer, I agree to abide by the standards of Kay's Kamp and to fulfill my volunteer responsibilities to the best of my abilities.

I hereby authorize Kay's Kamp to obtain information pertaining to any charges I may have for federal and state criminal law violations as part of a routine background check. The information will include convictions committed upon minors and adults and will be gathered from any law enforcement agency of this state or any other state or federal government to the full extent permitted by law.

I understand that such state and federal access is for the purpose of considering my application as a volunteer and that I expressly DO NOT authorize the Kamp, its' directors, officers, employees or other volunteers to disseminate this information in any way to any other individual, group, agency, organization or corporation.

I consent that photographic and/or video pictures may be taken for the purpose of obtaining publicity for Kay's Kamp or for providing documented materials to be shared with campers and staff. Such use may include, but shall not be limited to any advertisements, documentation of camp activities, or promotion on television, radio, newspaper, magazine, promotional film, webpage, flier, etc.

I understand there will be no compensation for the use of such materials and that materials so used, shall remain the property of The Kaylyn Elaine Warren Foundation. I agree to hold harmless The Kaylyn Elaine Warren Foundation, its employees, legal representatives or assigns and all persons acting under their authority from any liability that may arise from publication of such photographic and/or video material.

As a volunteer of Kay's Kamp, I agree that any medical/surgical emergency is my financial responsibility. In the case of a medical and/or surgical emergency, I authorize the Kay's Kamp medical team to render care or arrange for any x-rays, anesthetic, medical, dental, or surgical diagnosis, surgery or treatment and hospital care which is deemed advisable to and is under the supervision of any duly licensed physician, dentist or surgeon.

I acknowledge that certain activities at Kay's Kamp may have an increased risk of injury. I assume full responsibility of my safety. I agree to release and indemnify Kay's Kamp, the Kaylyn Elaine Warren Foundation, and all of its agents, representatives, employees (paid or voluntary) from any claims, costs, expenses, and/or damages which I may sustain or incur by joining in such activities, unless restrictions for such activities are noted by myself or my physician.

I understand that Kay's Kamp policy is to prohibit all forms of harassment by our volunteers. This includes sexual, racial, religious and other forms of harassment. I understand that failure to abide by Kay's Kamp policies is just cause for nonappointment, termination or disengagement as a volunteer.

While I am free to bring personal property items to Kay's Kamp, I understand that Kay's Kamp accepts no responsibility for the loss, damage or theft of any of my personal property.