Pennsylvania Clearances | The Splash Bash

Pennsylvania Affidavit of Volunteers

First name

Last name

Address

I am an unpaid volunteer

I swear or affirm that I am neither a perpetrator of a founded report of child abuse nor named in any Registry as the perpetrator of a founded report of child abuse.

I further swear or affirm that I have never been convicted of or pled guilty to any of the following offences: criminal homicide; aggravated assault; stalking; kidnapping; unlawful restraint; rape; statutory sexual assault; involuntary deviate sexual intercourse; sexual assault; aggravated incedent assault; indecent assault; indecent exposure; incest; concealing the death of a child; endangering the welfare of children; dealing in infant childred.

I further swear or affirm that I have never been convicted of or pled guilty to any of the following offences: Prostitution and related offenses; obscene and other sexual material and performances; corruption of minors; sexual abuse of children; or the attempt, solicitation or conspiracy to commit any of the aforementioned offenses.

I further attest and certify that I have not been convicted of an offense designated as a felony under the Controlled Substance, Drug, Device and Cosmetic Act.

I further attest and certify that I have not been convicted of an out-of-state or Federal offense similar in nature to the foregoing offenses listed in Paragraphs 5 and 6 above.

File upload

Signature

By signing above, you certify that the background clearances you have uploaded are current and comply with all state-mandated requirements for youth volunteers. You acknowledge your responsibility to ensure these clearances are accurate and up-to-date. If your clearances are found to be out of date or incomplete, you will not be permitted to enter the waterpark on the evening of the event. You further hereby swear or affirm that the statements set forth above are true and correct.