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Minor LPC Staff Criminal Record Disclosure Statement ({{gravity-field-id-7}})

Lone Prairie Camp’s staff screening requirements are an important part of protecting the minors whom we serve. In compliance with Alberta Camping Association standards, Lone Prairie Camp accepts this Criminal Record Disclosure Statement for minors if their local law enforcement agency is unwilling to process Police Information Checks for minors or the minor will be under 16 during the entire time they are serving at Lone Prairie Camp.

If you are unable to truthfully sign this document, please contact the Lone Prairie Camp Camp Director directly by emailing director@loneprairiecamp.com.

Attestation

I, the undersigned, hereby attest and affirm that (born and living at ):

Has no criminal convictions.
Has no pending court appearances for criminal offences.
Has no provincial statute convictions. (This includes traffic violation convictions if also signing an LPC Driver Waiver.)
Has no pending court appearances for provincial statute offences.
Has no court-imposed orders.
Has no non-conviction patterns of behaviour which may result in harm to vulnerable persons including other minors.

I, the undersigned, declare that the information provided in this statement is accurate and complete to the best of our knowledge. We understand that providing false or misleading information in this statement may result in immediate dismissal and legal consequences.

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Timestamp

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June 26, 2024 4:30 pm MST

Minor LPC Staff Criminal Record Disclosure Statement ({{gravity-field-id-7}}) Uploaded by LPC Registrar - registrar@loneprairiecamp.com IP 104.129.113.191

June 26, 2024 5:13 pm MST

Document owner director@loneprairiecamp.com has handed over this document to registrar@loneprairiecamp.com 2024-06-26 17:13:00 - 104.129.113.191