Worker Addendum

to the registration form for the

Mountain Top Baptist Assembly

•  I have been appointed by ________________________ to sponsor campers from

                                                                                church pastor, children's/youth pastor, or church

__________________________ for the ________________ camp.

                name of church                                                                                              year / name of camp

•  I have never abused or molested, or been accused or convicted of abusing or molesting, a child or a minor.

_______________________________

      Signature

_______________________________

printed name

__________

date