Congregational or Employer Verification Form
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Congregational or Employer Verification Formregarding child protection cackground checks for adult Youth leaders and chaperones attending Atlantic Coast Conference Bible Quizzing events. To be completed by congregational representative or employer only if original copies of background checks are maintained by congregational office or employer. I verify that the following individuals, who are likely to attend ACC Bible Quizzing in 2015, have all undergone, within the past three years: 1) the Pennsylvania Child Abuse History Clearance Certification; 2) the Pennsylvania State Police Request for Criminal Record Check; and 3) the FBI Fingerprint Check (unless, in the case of a volunteer, the individual has lived in Pennsylvania for the past ten years and swears or affirms in writing that they have not been convicted of any crime, in another state, similar to the convictions disqualifying a person in Pennsylvania) and that these checks are valid through the for the duration of the Bible Quizzing season. Our congregation or organization maintains the results of all background checks in a confidential location. Name(s) of Volunteer Leader or Chaperone Likely to Attend 2015 ACC Bible Quizzing: 1. 2. 3. 4. 5. 6. Each of the above-named individuals has undergone, within the past three years: 1) the Pennsylvania Child Abuse History Clearance Certification; 2) the Pennsylvania State Police Request for Criminal Record Check; and 3) the FBI Fingerprint Check (unless, in the case of a volunteer, the individual has lived in Pennsylvania for the past ten years and swears or affirms in writing that they have not been convicted of any crime, in another state, similar to the convictions disqualifying a person in Pennsylvania) and these checks are valid through the for the duration of the Bible Quizzing season. My congregation or organization has the results of background checks for each of the above individuals on file in a confidential location. ____ Yes ____ No ____ I’m not sure Continued on reverseNote: All paid and unpaid volunteer leaders or chaperones who attend an ACC Bible Quizzing event will be required to sign, at the beginning of that event, a “Volunteer Covenant” confirming that they: Have never been charged with or convicted of child abuse or any criminal conduct relating to children, Have undergone, within the past three years, the above-named background checks, and the results of their background checks are maintained by the church. Understand what constitutes “child abuse” under Pennsylvania’s Child Protective Services Law. Will not engage in any inappropriate or abusive conduct with children while attending this event. Understand their duty as a mandated reporter of suspected child abuse under Pennsylvania’s Child Protective Services Law. Name of Congregation/Employer __________________________________________________________ Name of Representative Completing this Form ___________________________________ (Please print) Signature of Representative Completing this Form ____________________________________________ Title of Congregational Representative/Employer _____________________________________________ Date ____________ Please return this form to: Atlantic Coast Conference c/o Brook Musselman Lancaster, PA 17602 office@atlanticcoastconference.net
Please contact the ACC office with any questions: office@atlanticcoastconference.net 717-394-8107 Atlantic Coast Conference Child Safety Policy: 1.29.15 Form B: Congregational Representative or Employer Verification Directory: 2015 2015 -> 587 Return function, r i(X) r i(0) r i(1) r i(2) r i(3) 1 0 2 4 6 Thermal Station, I 2 0 1 5 6 3 0 3 5 6 10 2015 -> Fall 2013 Spring 2014 Program Data: Standard 1 Exhibit 4d 2015 -> Police Militarization 2015 -> Medical Radiography Program 2015 -> 2015 ihbb championships: hs history Bowl Round 4 – Prelims First Quarter 2015 -> Desk review yemen 2015 -> Wrtp/big step · 3841 W. Wisconsin Ave., Milwaukee, wi 53208 2015 -> 1. naclo 2015 – North American Computational Linguistics Olympiad 2015 -> Rao bulletin 1 December 2015 html edition this bulletin contains the following articles 2015 -> Volume Ⅴ (2015) On The 2015 China Victory Day Parade Download 8.16 Kb. Share with your friends:
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