Volunteer Agreement for SS and LL

Volunteer Agreement

Ironwood Summer Staff and Leadership Live
Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Date Arriving at Ironwood*

MonthDayYear
Date
Expected Departure Date*

MonthDayYear
Date
Which Team are you serving on this Summer?*

Summer StaffLeadership Live
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Church Name
Church City/State
Do you agree to follow the Summer Staff Manual?*

YesNo
Does Ironwood have your permission to check your references and background for any accusations or convictions related to child abuse, etc.?*

YesNo
Have you ever been charged with or convicted of any violent crimes or crimes against children?*

YesNo
Insurance Company*
Policy Number*
I have read and agree to the following:

Hold Harmless Agreement: I, the undersigned, agree that in the event any claim for personal injury, property damage, or wrongful death shall be prosecuted against Ironwood or its officers, agents, or employees, that I will indemnify and hold harmless Ironwood and its officers, agents, or employees from any and all claims or causes of action.

In Case of Emergency: I, the undersigned, hereby give permission to the physician selected by the Camp Director or his agent to hospitalize, secure proper treatment for, or order injection, x-ray, anesthesia, or surgery for the undersigned.

Termination: It is understood that either party may terminate this agreement at any time.

Insurance Coverage: I, the undersigned, understand that my personal insurance will provide primary coverage for medical aid and Ironwood will provide excess coverage.
Name*
Signature*

Clear
Date*
Should be Empty: