Virtus

• First time counselors: The Diocese requires that all individuals who work with minors be Virtus trained. Virtus training can be done online and it takes around 1.5 hours. Online training instructions can be found here:

https://www.dmdiocese.org/filesimages/Victim%20Assistance/VIRTUS/VIRTUS%20Online%20Registration%20Instructions_2018.pdf

This link is also available on our website on our counselor page. The certificate that you receive after completion MUST BE ATTACHED TO THIS PACKET. Your printable certificate will be available under “Live Training” on your online profile.

If you have already been Virtus trained but never counseled, simply log in to your online Virtus account to find this documentation (http://www.virtus.org/virtus/) and attach it to this packet.

*The St. Thomas More Center does not have access to your online Virtus account. If you are having trouble logging in or finding your certificate, please contact the diocese.

• Veterans: Congratulations! If you have counseled at CYC before and previously turned in your Virtus certificate to the St. Thomas More Center, you DO NOT need to attach proof of Virtus.

Part 2: Background ScreeningEveryone, regardless of age, must complete this section. The required information is marked in yellow. Please review the Diocese of Des Moines Code of Conduct found under the documents sections on the left hand side of our counselor page.

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St. Thomas More Center Panora Alex Kautzky

515-309-1936 office@stmcenter.com

Catholic Youth Camp

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Part 3: Insurance Card Please attach a photo copy of the front and back of your insurance card to this packet.

Part 4: References

References are done completely online. Please choose two individuals (list their names below) and send them our “reference form link.” Please choose adults (that are not your

family members, that have seen you work in a professional setting) to act as your references.

Reference 1. ______________________________________

Reference 2. ______________________________________

Please send your references this link:

https://forms.gle/wshFW98kqhcZf5Sf7

This link is also found on stmcenter.com on the bottom of our counselor information page.

Part 5: Parental Consent Waiver (If you are below 18 years of age, please have your legal guardian sign

and date.)

Thank you for allowing my son/daughter mentioned above the opportunity to participate as a Catholic Youth Camp Counselor. In consideration for the numerous intangible spiritual and personal benefits which s/he will receive from this opportunity, I hereby offer the following.

I give permission for my son/daughter to participate in all of the activities during the camp week at St. Thomas More Center and I assume responsibility for his/her transportation to and from the St. Thomas More Center.

I hereby waive the Diocese of Des Moines, the St. Thomas More Center, its staff and volunteers from any and all liability for accident or injury which might occur from my son/daughter participating at Catholic Youth Camp.

I understand that first aid treatment will be offered in case of injury or illness and if serious illness or injury develops, medical and/or hospital care will be given. I further understand that in case of serious injury or illness attempts will be made to notify me. If it is impossible to contact me, I give permission for emergency treatment or surgery as recommended by the attending physician. I furthermore understand that I am responsible for any doctor, hospital and/or ambulance fees arising from the treatment of my child and all medicines required from treatment.

Name (please print): _________________________________

Signature: _______________________________________ Date: __________________

PERMISSION, RELEASE, AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT IN CONSIDERATION of the ability of a minor child (“Camper”) to participate in Saint Thomas More Camp (the “Camp”), each of the undersigned for himself/herself, his/her personal representatives, heirs, and next of kin: Acknowledges, agrees, and represents that he/she is a parent or legal guardian of the Camper.Acknowledges, agrees and represents that he/she gives permission for the Camper to participate in all aspects of the Camp.HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Saint Thomas More, its employees, instructors, or agents, or other owners or lessees of the premises and equipment used in the Camp and others who give recommendations, directions or instructions or engage in risk evaluation, loss control or insurance activities regarding the premises, equipment or any activity associated with the Camp, and each of them, their directors, officers, agents and employees, all for the purposes herein referred to as “Releases,” FROM ALL LIABILITY TO THE UNDERSIGNED, his/her personal representatives, assigns, heirs, and next of kin FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE MINOR IDENTIFIED ABOVE OR PROPERTY OR RESULTING IN DEATH OF THE MINOR IDENTIFIED ABOVE ARISING OUT OF OR RELATED TO USE OF AND/OR PARTICIPATION IN THE CAMP, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them FROM ANY LOSS, LIABILITY, DAMAGE, OR COST they may incur arising out of or related to the above-named minor’s participation in the Camp, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or related to the Camper’s participation in the Camp, WHETHER CAUSED BY THE NEGLIGENCE OR RELEASES OR OTHERWISE.HEREBY acknowledges the Camper’s participation in the Camp may be dangerous and involve the risk of serious injury and/or death and/or property damage. He/she acknowledges the Camper is voluntarily participating in the Camp with the undersigned’s full knowledge of the dangers involved, and the undersigned hereby agrees to accept ANY AND ALL RISKS of property damage, personal injury, and/or death arising out of or related to the Camper’s participation in the Camp, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. He/she also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES and hereby agrees to accept ANY AND ALL RISKS of property damage, personal injury, and/or death arising out of or related to such rescue operations or procedures of the releases.HEREBY agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to ALL NEGLIGENT ACTS by the Releases, and is intended to be as broad and inclusive as is permitted by the laws of the State of Iowa, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.HEREBY agrees to indemnify and save and hold harmless the Releasees and each of them from any loss, liability, damage, or cost they may incur arising out of related to any loss of consortium claim brought by his/her spouse and/or children brought as a result of or related to the Camp, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE. The undersigned specifically recognizes and agrees that loss and cost described in this paragraph includes reasonable attorney’s fees, expert expenses and litigation costs incurred in the defense of any loss of consortium claim identified above. HEREBY agrees that in the event the Camper sustains any injury or illness in connection with the Camp the undersigned hereby authorizes first aid, medicine, medical treatment or surgery deemed necessary. HEREBY consents to allow any pictures, videos and or voice likenesses of the Camper to appear in any document or promotional materials of Saint Thomas More Camp without any compensation to the undersigned. I CERTIFY THAT I HAVE READ THIS PERMISSION, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT. I CERTIFY THAT I FULLY UNDERSTAND ITS TERMS AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I AM OF LEGAL AGE AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT MY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME. I INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Signature: ______________________________________________________________ Date: ____________________

Non-Prescription Medication Agreement

I hereby grant permission for nonprescription medication to be given to my child, if deemed necessary.

Signature: ______________________________________________________________ Date: ____________________

First Aid Agreement I verify that all the above information is correct. I understand that first aid will be available at the camp; that if a serious illness or injury develops, medical and/or hospital care will be given. However, the camp staff is not responsible in case of accidental injury or illness. I further understand that in case of serious injury or illness we will be notified, but if it is impossible to contact us, we give permission for emergency treatment or surgery as recommended by attending physician. I further understand that I am responsible for payment of any doctor and/or hospital fees arising from the treatment of my child. To assist the doctor and/or hospital in that task we provide this information.

Signature: ______________________________________________________________ Date: ____________________

Photo and Video Release Agreement I hereby authorize Catholic Youth Camp (CYC), to publish photographs and video taken of myself and/or my child(ren) while I and/or my child(ren) is/are on site at CYC and their names and likenesses, for use in CYC print, online, and video marketing materials, as well as other CYC publications. I hereby release and hold harmless CYC from any reasonable expectation of privacy and confidentiality for myself or child(ren) associated with this registration or otherwise. Further, I attest that, in the case of a minor, I am the parent or legal guardian of the child being registered and that I have full authority to consent and authorize CYC to use their likeness and name. I hereby release CYC, its contractors, employees, and any third parties involved in the creation or publication of CYC publication, from liability for any claims by me or any third party in connection with my participation or the participation of the minor child(ren).

Signature: ______________________________________________________________ Date: ____________________

This liability waiver must be signed by either; a parental guardian if you’re under the age of 18, or if you’re over the age of 18 by you.

Counselor Training information If you are a new counselor or have not counseled for three years, you are required to attend a counselor training. Veteran counselors are definitely welcome to join but are not required. Come ready to make new friends, try CYC activities, and prepare for an incredible summer!

*You will select your counselor training date in your online application. **New counselors who do not attend a training, will not be able to counsel.

Dates: • April 18 (Note: This training will be offsite, due to a scheduling conflict) • May 9 • May 29

Please arrive at 12:00pm. (Lunch will be provided) We will close at 4:00pm.

If you can no longer attend your selected date, please email or call the office to sign up for the other date.

Volunteers like you make CYC possible. We truly appreciate your interest in serving our youth. Feel free to contact the office at 515-309-1936 or office@stmcenter.com if you have any questions. Thank you!

Checklist Please make sure your packet is complete by reviewing this checklist. If you are a new counselor, please bring your completed packet to your counselor training. Returning counselors must mail their packets to CYC by May 1st.

Catholic Youth Camp (Counselor Packet) 6177 Panorama Rd Panora, IA. 50216

____ I have attached my Virtus certificate to this packet or have previously turned in my certificate to Catholic Youth Camp in years past.

____ I have completed the background screening application.

____ I have attached a photo copy of the front and back of my insurance card to this packet.

____ I have sent my two individuals the online reference link.

____ My legal guardian has signed and dated the Parental Consent Waiver and

Liability waiver (Liability waiver needs to be signed by everyone!)

KEEP THIS PAGE!Keep this information for yourself. On this page you’ll find helpful hints and expectations of counseling.

Tips • When registering online make sure we have a current way to

contact you. Email and phone number. We let you know about all the important things via email, like your counseling assignments, reminders, etc.

• When calendaring your time for camp remember to include the Saturday (usually) in your plans. YOU HAVE TO BE AT CAMP AT 11am The Day Before Camp for all the fun team building and prepping for the week.

• Read carefully, make sure to double check where you’re signing if you have any questions get in touch with the office!!

• ….for that matter if you have any questions or need help with anything we’re here for you. Please don’t hesitate to reach out. office@stmcenter.com or kelly@stmcenter.com

• Don’t forget your service hour forms! If you have a piece of paper that we’re supposed to sign, bring it with you the week of camp. (Otherwise Kelly can help you out in the off-season).

Important Dates

Counseling Assignment

Retreat Date (if needed)