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BOY SCOUTS OF AMERICA

MINSI TRAILS COUNCIL

Waiver of PA Mandated Background Checks

While I am an adult who has applied for an unpaid position as a volunteer with the Boy Scouts of America,

in my position, I am neither responsible for the welfare of a child nor have direct volunteer contact with

children and therefore, am not required to obtain the PA Mandated Background Checks.

I swear/affirm that neither of the following are part of my responsibilities:

 Acting in lieu of or on behalf of a parent (at no point am I the person in charge of children).

 Providing care, supervision, guidance or control of children and having regular and repeated contact

that is integral to my volunteer responsibilities. (I do not attend camping trips as a leader or assist at

more than 3 meetings or activities with Scouts per year.)

I further swear/affirm that:

 I do not present myself as a leader or authoritative figure in the Boy Scouts of America.

 If I wear the Scout uniform, it is only for ceremony and not to represent authority.

I further swear/affirm that I reviewed, understand and have completed the Disclosure Statement Application

for Volunteers not subject to the PA Mandated Background Checks.

Should my position or responsibilities change, requiring me to obtain the PA Mandated Background Checks,

I realize I must submit those certifications to Minsi Trails Council, Boy Scouts of America, before assuming

the new position or responsibilities.

BSA Member ID Number:______________________ Unit Type:________ Unit #:_______

Volunteer Position:___________________________________________________________

Name:_________________________ Signature:___________________________________

Unit Verification –

Name:_________________________ Signature:___________________________________

Date:_____________________ Volunteer Position:_________________________________

Positions this Waiver may apply to include: Chartered Organization Representative, Committee Chair, Committee Member, Unit

College Scouter Reserve, Unit Scouter Reserve, Pack Trainer.

RETURN THIS FORM TO YOUR UNIT

COMMITTEE CHAIR.

h:\palaw153\WaiverofPAMandatedBackgroundChecks&DisclosurStatementforVol 10 5 2015

Waiver Of Pa Mandated Background Checks - Boy Scouts Of America, Minsi Trails Council