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Work History

 Previous Employment & Direct Supervisor 

Three References (non-relative)

Health History

 Please Check all that apply to you and your health history 

A health history is required by the Massachusetts Department of Public Health for all summer camp staff and campers. Please know that we value your privacy. Information provided is available only to the camp director and camp health staff.

Emergency Contact

In order to travel with Engage you must comply with the regulations of the Massachusetts Department of Public Health which includes documented records of Immunizations, a Physical Examination, Concussion training, the CORI background check and SORI sex offender check. Without these records, you will not be eligible to travel as summer staff. Please complete the forms below by uploading the appropriate documents:

Immunization Records

The Massachusetts Department of Public Health requires that every camper and full time staff person shall prior to attending camp, furnish to the camp a certificate of immunization, prepared and signed by a licensed health care provider:

Please upload a copy of your immunization records below.

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Physical Examination

The Massachusetts Department of Public Health requires that every camper and full time staff person shall prior to attending camp, furnish to the camp proof of a physical examination, prepared and signed by a licensed health care provider:

Please upload a copy of your Physical below.

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Concussion Training

The Massachusetts Department of Public Health requires that every full time staff person shall prior to attending camp, furnish to the camp proof of a concussion training certificate:

Process:

1. https://www.cdc.gov/headsup/youthsports/training/index.html

2. Click "Launch the HEADS UP course"

3. Complete the free training and you will receive the certificate, download it and upload it below before in order to submit and complete this form

Please upload a copy of your concussion training certificate below.

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Background Checks

The Massachusetts Department of Public Health requires that every full time staff person shall prior to attending camp, have a background free of conduct that bears adversely upon his or her ability to provide for the safety and well-being of the campers. We are required to obtain a sex offender registry information check from the Massachusetts Sex Offenders Registry Board and a CORI/Juvenile Report from the Department of Criminal Justice Information Services. 

*Other background checks outside of the CORI/SORI forms stated above do not meet the criteria of eligibility. 

Process:

1. Download the CORI form below and print it out

 

 

2. Fill/sign the printed copy BY HAND and either scan it to your computer or simply take a picture of it on your phone and upload it below:

 

 

Lastly, please upload a copy of your ID as that is necessary to run the background check.

 

 

 

 

We will run the report with the information you provide on that form and let you know if you passed or failed the both background checks.

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