Peace Camp 2022 Volunteer Form

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Thank you for volunteering for Peace Camp 2022!

Peace Camp will take place from June 20 - 24, 2022 from 9 AM-3 PM each day at the Gather Community Space at the First Presbyterian Church on South Franklin Street in Wilkes-Barre.

If you have any questions, please email peacecamp@peaceandjusticecenter.com.

The following clearances are required for volunteers over 18 who will have direct contact with children:

1) Pennsylvania Child Abuse History Clearances (CCY113)
2) Pennsylvania Criminal Record Checks for Volunteers (SP-164A)
3) (If you have lived outside Pennsylvania in the last 10 years) FBI Criminal Background Checks.

To apply for your clearances, you can request the first two forms through the following Pennsylvania Government Web sites:

Pennsylvania Child Abuse History Clearances (CCY113): https://www.dhs.pa.gov/KeepKidsSafe/Clearances/Pages/PA-Child-Abuse-History-Clearance.aspx

Pennsylvania Criminal Record Checks for Volunteers (SP-164A): https://epatch.state.pa.us

You may call the FBI Background Check Unit at (717) 783-6211 for information about #3.

If you already have been cleared within the past five years, either for volunteering or employment, your clearances are still in effect and you simply need to submit a copy. If you have not ever applied for these kinds of clearances, then because you are a new volunteer applicant your fees will be waived. Please don’t wait to obtain your clearances because the turnaround time can be up to 2 weeks.

Need help figuring this out? Call the Peace Center at (570) 823-9977 or email peacecamp@peaceandjusticecenter.com.

Thank you very much for helping us create a safe environment!

Email *

Name: *

Street Address *

City *

State *

Zip Code *

Phone Number *

If you are 18 or older, have you submitted your clearances to the Peace and Justice Center?

Yes

No, but I have applied for the clearances and will submit as soon as possible

Clear selection

Age of volunteer *

Over 18 years old

Under 18 years old

If volunteer is under 18, please list date of birth:

YYYY

If the volunteer is in school, what is their current grade?

Any allergies, medical issues, needs, etc. of which planners need to be aware?

If volunteer is under 18, please provide a parent/guardian name and phone number:

If the volunteer is under age 18, please have a parent or guardian check each item below to acknowledge their consent to allow participation.

Obtaining emergency medical care

Administration of minor first-aid to campers

Outdoor recreation

Walking trips

Photo release (print publications, electronic materials)

Here is what I can do... (please check all that apply to you) *

Teach a class

Assist leaders

Food pickup (vehicle needed)

Be a counselor

Help with registration

Play an instrument

Take photos

Help with meals and snacks

Provide a program

Make phone calls

Help with a service project

Read stories

Play games

Serve as camp nurse

Prepare activity materials

Have fun!!

Required

Please type full name as signature. If the volunteer is under 18, please have a parent/guardian type full name as signature. *

A copy of your responses will be emailed to the address you provided.

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