Please answer yes or no to all of the below questions. If you answer YES to any of the questions please explain in the space provided or in a separate email.

* Indecent assault and battery on a child or adult * Assault or kidnapping with intent to commit rape * Rape of a child or adult * Distributions and trafficking of narcotics or other controlled substances

Please read the following statement. When you have finished reading the statement please click the "submit" button below. By clicking 'Submit' below, you agree to the below statement, and the validity of the answers to the questions above. This stands as your signature to that effect. Privacy Policy

I understand that: a) The camp may deny employment to any person who answers "yes" to any one of questions 1-6. 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 of a minor; 2) have resigned, been terminated, or been asked to resign from a position whether paid or unpaid, due to complaint(s) of a sexual abuse of a minor; and/or 3)have falsified or omitted information in this disclosure statement. d) This disclosure statement must be updated yearly.