Nazarene Disaster Response

I understand that I will recieve a link via the email address provided on this form for completion of a criminal background search and the information obtained from that search will be used solely for the purpose of determining eligibility to deploy as a volunteer with East Tennessee Nazarene Disaster Response (ETNDR). I understand that failure to complete the background search or unsatisfactory findings stemming from the background search will result in being ineligible for deployment with ETNDR. I understand that this examination is being completed on a voluntary basis. I understand that the cost for the background search is between $12.00 and $15.00 and I will be responsible the cost for the background check not to exceed $15.00 unless otherwise agreed upon.

I willingly participate in the activities associated with the ministries of the East Tennessee District Nazarene Disaster Response (NDR) of the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries. I understand that some of the activities may be physically strenuous. I release the East Tennessee NDR Team, the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries, its council members, agents, volunteers, and partners from responsibility for accidental injury, including death or illness, while engaged in any disaster response activities, or while en route to said activities. In the event that I become ill or sustain an injury while participating in these activities, I give permission to the council members, agents, volunteers, or partners to administer first aid. In the event of an emergency, I hereby give permission and authorize a physician and/or dentist to secure or administer emergency medical treatment including X-ray examination, anesthetic, medical, dental, or surgical diagnosis and treatment including hospital care if necessary and the administration of drugs or medicine to be rendered to me under the general or specialized supervision and upon the advice of a duly licensed dentist, physician and/or surgeon, or medical personnel. I understand that this consent will apply to all emergency situations and copy of this form is as valid as the original. I also understand this includes COVID-19 protocols, treatments, quarantines, of the local jurisdiction(s) I will be in. It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required, but is given to provide authority to the council members, agents or volunteers, to consent to treatment in the exercise his/her best judgment on what is advisable for my care upon advice of such physician, dentist, or surgeon or medical personnel. It is understood the attending physician is permitted to speak with my emergency contact in collaboration with council members, agents or volunteers. I agree to remain fully liable and responsible for the payment of such treatment. When treatment is completed, I specifically instruct any treating health care provider to release physical custody of myself to the council member, volunteer, or E.T. NDR partner who presents me for treatment. I understand that the East Tennessee NDR Team, the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries, all their council members, agents and adult chaperones/volunteers and partners are not responsible for the loss of or damage to personal belongings brought to the activities. In the event of misconduct, unbecoming of a member of the Church of the Nazarene (whether you are a member or not) I understand I can be dismissed from this project. Furthermore, I agree to abide by the decisions as final in regard to misconduct by those representing East Tennessee NDR Team, the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries, E.T. NDR partners, and I release them of any liability or legal response for their decision in regard to misconduct. I agree to be responsible for all expenses incurred as a result of dismissal including transportation, lodging, food, incidental, or any emergency I might incur post dismissal. I understand that the East Tennessee NDR Team, the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries, its council members, agents, volunteers and/or partners may take pictures, photos, videos, or use other social media to advertise, or promote East Tennessee NDR Team, the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries, or Partner activities in which I am participating. I give permission to be photographed, to make videos or filmed, and for these pictures, photos and/or videos to be used on social media for promotion of or advertising for East Tennessee NDR and/or any of E.T. NDR partners. I the undersigned, do hereby verify that the health information contained in this document is correct and I do hereby release and forever discharge the East Tennessee NDR Team, the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries, its council members, agents, volunteers, and/or partners from any and all claims, demands, actions or causes of action, past, present or future arising out of any accidental injury, including death or illness, or loss of property while participating in these activities. I agree to indemnify the East Tennessee NDR Team, the East Tennessee District Church of the Nazarene, The General Church of the Nazarene and Nazarene Compassionate Ministries, and E.T. NDR partners for any and all claims, demands, damages, injuries, costs, suits or causes of action, past, present or future, arising out of or caused by my participating in these activities. This authorization shall remain in effect unless revoked in writing prior to any disaster response activity I am scheduled to participate in.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.