Exchange Life Summer Camp Counselor Application 2024

The Danbury Lodge
14011 CR 602
Danbury, TX 77534

Consumer Report/Disclosure Notification, Applicant Verification and Release, and Pastor’s Reference.

Please answer the following questions, using an additional page for the answers if you prefer.

Organization Program Dates Contract
Church Activity
Church Name Pastor’s Name Years Attended
Name/Relationship Address Phone
BACKGROUND INFORMATION

I understand that a Background report may be obtained. I hereby authorize a criminal background (criminal history) search which includes a search of local, state and federal courts and/or law enforcement agencies and release all individuals, companies, corporations, and agencies, public or private, connected therewith from any and all liability associated with the dissemination of such information pertaining to me. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent that such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living.

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