Camp Wack Volunteer Registration

Camp WACK

Volunteer Registration
Name*

Legal First NameMiddle InitialLast Name
Preferred Name/Nickname (optional)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Email*
example@example.com
Birthdate*

MonthDayYear
Sex*

MaleFemale

Are you CPR certified? *

YesNo
Expiration date of certification?
Are you lifeguard certified?*

YesNo
Expiration date of certification
Emergency Contact Name*
Emergency Contact Phone*
Please enter a valid phone number.
Relationship to you
Health Insurance Company*
Group/Policy #*
Photo and Information Release

Please use any and all images of myself from Camp WACK. I understand that you have my best interest at heart and would not portray me in a negative image. These images will be used on the web-site, in printed materials and during presentations to help promote the Camp WACK opportunity along with my first name.
Photo Release Agreement*

YesNo

The following items are required to conduct background checks for volunteers 18 years of age and over.
Place of Birth (City, State)*
Previous Name if Married in last 5 years (First, MI, Last)
Race*

American Indian / AlaskanAsian / Pacific IslanderBlackMulit RacialWhite
Criminal History

Due to the fact that volunteers are working with children a criminal BACKGROUND CHECK is required for all volunteers. By saying YES to "signature" below you are agreeing to a background check. If you are a returning Camp Wack volunteer, you are providing statement that the criminal history you have previously provided has not changed.
Ever been convicted of any crime including sex related or child abuse related offenses?*

YesNo
I authorize investigation of all statements herein and release the camp and all other from liability in connection with the same. I understand that, if accepted, I will be an at-will volunteer. I also understand that untrue, misleading, or omitted information may result in non-acceptance or dismissal, regardless of the time of discovery by the camp and/or it's directors.
Your signature or signature of parent/guardian if under 18*

Clear

2025 CAMP WACK Volunteer ACKNOWLEDGEMENT

Volunteer acknowledges that Modified Athletics For Kids, Inc. ("Modified Athletics") operates an adaptive water skiing day camp ("Camp WACK"), and Volunteer desires to volunteer to assist with the operation of Camp WACK. Prior to volunteering at Camp WACK, Modified Athletics has requested Volunteer to review and acknowledge the following policies regarding the treatment of personal, private or other sensitive information Volunteer may come into contact with while volunteering at Camp WACK.

Volunteer acknowledges the following:
1. Private Information. Volunteer acknowledges that while assisting Modified Athletics, Volunteer may come into contact with or learn of certain private information, including but not limited to, the name, birthdate, medical conditions, other personal information of the Camp WACK participants, staff, and volunteers, and passwords or other security measures used to protect such information ("Private Information").
2. Volunteer Conduct. Volunteer acknowledges that as a condition to volunteering with Modified Athletics, he/she will only use Private Information as directed by Modified Athletics. Furthermore Volunteer agrees not to disclose, publish, duplicate, photograph, or otherwise share through interpersonal or social media means any Private Information without the prior written consent of Modified Athletics, unless otherwise permitted by law. This obligation will commence on the execution of this acknowledgement and continue in perpetuity.
3. Indemnity. Volunteer shall indemnify and hold harmless Modified Athletics and its officers, directors, employees, agents, and representatives against, and in respect of, any claims, losses, expenses, costs, liabilities, and damages, including reasonable attorneys’ fees, arising out of any action or inaction of Volunteer. Modified Athletics will not be liable for any injury or damage to any person or property whatsoever by reason of, or in any manner growing out of, any of Volunteer’s action or inaction.
4. Entire Agreement. This acknowledgment contains all terms relating to the subject matter hereof.
By signing, the volunteer acknowledges the above.
Signature of volunteer*

Clear
Is volunteer a minor?*

YesNo
Signature of parent or guardian*

Clear
Should be Empty:

Camp WACK

Photo and Information Release

Criminal History