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Verification Agreement
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I am completing this Verification Form for my _______________
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Parish or School Youth Group
Community Group (Ex. Family or Friend Group)
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Camp Attending
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BILLINGS, MT (June 23-29)
BOWLING GREEN, KY
BRITT, IA
CHAMPAIGN, IL
CINCINNATI, OH
DREXEL HILL, PA (PHILLY)
FARMINGTON HILLS, MI
HUNTINGBURG, IN
JACKSONVILLE, FL
KANSAS CITY, KS
KNOXVILLE, TN (June 22-27)
LOUISVILLE, KY
MEMPHIS, TN
MILWAUKEE, WI - New Host Location for 2025!
MONTAGUE, MI
MORGANTON, NC
NASHVILLE, TN
NEW BRAUNFELS, TX
NEW CASTLE, PA
NIAGARA FALLS, NY
NORTH HALEDON, NJ
RICHMOND, VA
ROME & ASSISI (July 13-23, 2025)
ST. LOUIS, MO - Details coming soon!
TBD
Name of Parish
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Ex. All Saints Catholic Church, Knoxville
Name of Group
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Please list the names of all adults attending (18+ at the time of camp)
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Ex. Michael Jordan, Harry Potter, Crystal Ball
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Are there any policies your group must follow as established by your diocese?
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Yes
No
Example: Specific sleeping accommodations, shower guidelines, adult to teen ratios, etc.
Please explain
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Verification Agreement: Parish or School
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AGREE
*Please read carefully before signing.*
The undersigned, on behalf of the Parish named above, its youth programs, and its Diocese, hereby certify to CATHOLIC HEART WORKCAMP, L.L.C., a Florida limited liability company (including its members, managers, agents, and affiliates) (“CHWC”), that each adult (18 years of age and older) attending the Workcamp described above either as a chaperone or youth participant has successfully completed the requirements of their Parish and its Diocese in regard to sexual abuse risk prevention policies, training, and background checks to verify the suitability of such adults to work or participate with minors in connection with the Parish, its youth programs, and its Diocese, or if there are no such requirements, has successfully completed the requirements of CHWC by (a) being in compliance at all times with CHWC’s sexual abuse prevention policies and (b) by conducting sexual abuse risk prevention background checks to verify the suitability of such adults to work or participate with minors in connection with the Workcamp described above.
At least ten (10) days prior to the Workcamp described above, the undersigned agrees, if requested, to provide CHWC written proof of the Parish’s insurance coverage regarding sexual abuse claims and written certification that such background checks were conducted with no adverse findings.
Each party to this agreement shall indemnify, defend, and hold harmless the other party (including its officers, directors, managers, trustees, agents, employees, and owners) from and against any and all demands, claims, damages, losses, expenses, and liabilities, including reasonable attorneys’ fees, to persons or property (collectively the “Claims”), arising out of or caused by the indemnifying party’s negligence or willful misconduct in connection with the provisions of this Agreement. This paragraph shall not waive any defenses a party may have with respect to any Claims.
The undersigned further certifies that they have witnessed or otherwise verified that all signatures from their group on all forms relative to the Workcamp described above are the true signatures of the persons whose signatures appear on those forms.
Florida law shall apply to this agreement and any Claims, and venue shall be the courts of Orange County, Florida.
Verification Agreement: Community
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AGREE
*Please read carefully before signing.*
The undersigned, on behalf of the Group and all individuals named above hereby certify to CATHOLIC HEART WORKCAMP, L.L.C., a Florida limited liability company (including its members, managers, agents, and affiliates) ("CHWC"), that each adult (18 years of age and older) attending the Workcamp described above either as a chaperone or youth participant has successfully completed the requirements of their Parish and its Diocese in regard to sexual abuse risk prevention policies, training, and background checks to verify the suitability of such adults to work or participate with minors in connection with the Parish, its youth programs, and its Diocese, or if there are no such requirements, has successfully completed the requirements of CHWC by (a) being in compliance at all times with CHWC's sexual abuse prevention policies and (b) by conducting sexual abuse risk prevention background checks to verify the suitability of such adults to work or participate with minors in connection with the Workcamp described above.
At least ten (10) days prior to the Workcamp described above, the undersigned agrees, if requested, to provide CHWC written certification that such background checks were conducted with no adverse findings.
Each party to this agreement shall indemnify, defend, and hold harmless the other party (including its officers, directors, managers, trustees, agents, employees, and owners) from and against any and all demands, claims, damages, losses, expenses, and liabilities, including reasonable attorneys' fees, to persons or property (collectively the "Claims"), arising out of or caused by the indemnifying party's negligence or willful misconduct in connection with the provisions of this Agreement. This paragraph shall not waive any defenses a party may have with respect to any Claims.
The undersigned further certifies that they have witnessed or otherwise verified that all signatures from their group on all forms relative to the Workcamp described above are the true signatures of the persons whose signatures appear on those forms.
Florida law shall apply to this agreement and any Claims, and venue shall be the courts of Orange County, Florida.
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Contact Leaders Name
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First
Last
Contact Leader's Email
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Name (Safe Environment Compliance Officer)
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First
Last
Email (Safe Environment Compliance Officer)
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Signature (Safe Environment Compliance Officer)
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Clear Signature
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Waiting List
Submission will be added in the order that are received.
Full Name
Phone Number
Email Address
How many spots you would like?
Are you already registered for a different camp and looking to switch if space becomes available?
Yes
No
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