Leader'S Reference Form - Ben Delatour Scout Ranch Summer Camp printable pdf download

Adult Leader Reference Form Page 1 of 2

ALL ADULT LEADERS ATTENDING BEN DELATOUR SCOUT

RANCH SUMMER CAMP MUST COMPLETE THIS LEADER’S

REFERENCE FORM:

PURSUANT TO: COLORADO DEPARTMENT OF HUMAN SERVICES, MINIMUM RULES AND REGULATIONS FOR CHILDREN’S CAMPS,

GENERAL REQUIREMENTS FOR ALL PERSONNEL 7.711.21d AND GENERAL RULES 7.701.53A

Leader’s Name: ________________________________________

Troop #: _____________ Council: ________________________

Dates attending camp: __________________________________

This form is to be filled out by any adult who will be spending a night at Ben Delatour Scout Ranch – Boy Scout

Camps – during our summer camping season.

1- ROLE OF THE UNIT LEADER/ADULT IN CAMP:

It is the role of the unit leader/adult to supervise and monitor the youth in their unit. Unit leaders shall not have

any other duties that would detract from the responsibility of service as a leader.

2- CHARGES OR CONVICTIONS:

Have you ever been charged with or convicted of any charge of child abuse or neglect, unlawful sexual offense,

Circle one: YES

or felony?

3- PERJURY & UNDERSTANDING & REPORTING OF CHILD ABUSE

Child abuse consists of a wide variety of different problems. Usually these are categorized as physical abuse, emotional

abuse, sexual abuse and neglect. Physical abuse is the injury of the child by other than accidental means. Emotional abuse

is the constant belittling, criticizing, yelling at and verbal tearing down of the child. Sexual abuse is any sexual activity between

a child and an adult, or sexual activity involving children in which the age, size or other power factors between the participants

is unequal. Child neglect is failure to provide necessary nurturance when resources are available to do so. Under the “Child

Protection Act of 1987” (C.R.S. 19-3-301) in the Colorado Children’s Code, leaders are required to report suspected child

abuse or neglect. The law at 19-3-304 states that if a leader has “reasonable cause to know or suspect that a child has been

subjected to abuse or neglect or who has observed the child being subjected to circumstances or conditions which would

reasonably result in abuse or neglect shall immediately report” such information to the Camp Director. It is not the leader’s

role to investigate suspected abuse – only to report it. Persons who make a good faith report are immune from civil and

criminal liability. Additionally, the law provides for the protection of the identity of the reporting party. A leader who fails to

report suspected child abuse or neglect commits a class 3 misdemeanor and will be punished as provided in section 18-1-106,

C.R.S.

Perjury Statement: Any Adult who knowingly or willfully makes a false statement of any material fact or thing in the

application is guilty of perjury in the second degree as defined in Section 18-8-503, C.R.S., and upon conviction thereof, shall

be punished accordingly. Suspected Child Abuse can be reported to the Larimer County Dept. of Human Services – 970-498-

6300.

A message from the Larimer County Department of Social Services.

The Ben Delatour Scout Ranch is a child care facility licensed by the Colorado Department of Human Services. The license

indicates that the program and facilities have met the required standards to operate a child care facility. To file a

complaint about this facility or report child abuse, please contact:

Larimer County Social Services

Child Protection Division

970 498-6900

I have read and understand the above requirements concerning my responsibility regarding child

abuse reporting, and my Role of the unit leader/adult in camp.

Leader'S Reference Form - Ben Delatour Scout Ranch Summer Camp

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