Camp Mulberry Volunteer Registration 2018

VOLUNTEERS MUST BE OVER THE AGE OF 19, GRADUATED FROM HIGH SCHOOL, AND APPROVED BY THE PASTOR OF THEIR HOME CHURCH.

The Camp Director reserves the right to accept or reject any applicant for any reason he deems necessary for the betterment of the camp.

SENIOR CAMP IS JUNE 8-13.

JUNIOR CAMP/DAY CAMP IS JULY 19-22.

Volunteers who are able are encouraged to arrive early if possible and plan to stay after the end of the camp they're working at to help shut down the camp grounds.

Which camp will you be volunteering for?

Senior Camp (June 8-13)Junior Camp (July 19-22)Day Camp (July 19-22)Both Camps

Name*

First NameLast Name

Age*

Gender*

MaleFemale

Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

E-mail*

You will receive a confirmation email.

Phone Number*

Do you want a camp shirt?*

YesNo

Size*

All volunteers receive a FREE Camp Mulberry T-shirt.

Home Church*

Home Church City*

State*

Pastor's Name*

First NameLast Name

Pastor's Phone Number*

Pastor's Email*

Email Selector

WE WILL CONTACT YOUR PASTOR FOR HIS APPROVAL OF YOUR APPLICATION.

In case of emergency, contact:*

First NameLast Name

Emergency Contact*

Relationship to Volunteer*

Alternate Contact*

First NameLast Name

Alternate Emergency Contact*

Relationship to Volunteer*

Section A: Medical Information

Are you currently being treated for any medical conditions, including head lice?*

YesNo

If Yes, please list below:*

Are you currently taking any medications?*

YesNo

If Yes, please list below:*

Are you allergic to any medications?*

YesNo

If Yes, please list below:*

Do you have any other allergies (i.e. food allergies)?*

YesNo

If Yes, please list below:*

Tetanus Immunization*

YesNo

Date of Immunization*

MonthDayYear

Do you have any special dietary needs?*

YesNo

If Yes, please list below:*

Are there any activities that you should not participate in?*

YesNo

If Yes, please list below:*

Will you be staying on campus?

Yes, I will stay on campusNo, I will be staying off campus

What would be your ideal job as a volunteer at Camp?

While we try to fit everybody to jobs that they're suited for, there is no guaruntee that you will be given your jobs of choice.

First Choice (I would LOVE to do this!)

Second Choice (I would LIKE to do this!)

Last Choice (Oh God, anything but that!)

Please provide any addition information here.

Section B: Medical Insurance Information

Insurance Company*

Group Number*

Policy/ID Number*

Subscriber Name*

Subscriber Phone Number*

Subscriber Employer*

Subscriber Work Phone Number*

By signing this form, I, the undersigned, do give my permission for the camp director, medical staff, camp staff, adult present or in charge of first aid, or church official responsible to provide medical treatment in the case of sickness or injury to me, while on the campgrounds.

I have listed any and all activities in which I cannot participate on this form in the allotted space above. Camp Mulberry is staffed with a Licensed Registered Nurse. If the staff at Camp Mulberry, see that I need medical attention that the camp health professional cannot give, the emergency contact listed above will be notified and I will be taken to a nearby hospital. Camp Mulberry is not responsible for any injury I may experience while I am on campus.

I, the undersigned, will be responsible for all medical treatment and/or medications that may be necessary, beginning Sunday prior to the first day of camp and continuing until the Sunday after the last day of camp. The Associated Brotherhood of Christians, Camp Mulberry, or any of its officials or staff will not pay for or be responsible to pay for any medical treatments or medications. All responsibility will lie with the me, the undersigned.

I acknowledge that I have completely understood this release statement and all its terms and by checking the box below, I consent to the use of this e-signature and understand that by e-signing I am legally bound to the terms of this document.

I agree to the terms and conditions above.

I hereby release, indemnify and hold harmless the Associated Brotherhood of Christians, Camp Mulberry, and its staff from any and all liability in connection with injury (including injury caused by neglect) in conjunction with my volunteer service for Camp Mulberry. I certify that I am in good health & able to participate in volunteer service. I certify that I am over the age of 20 and am competent to contract my name insofar as the above is concerned. I have read the foregoing release, authorization and agreement, before affixing my signature below and warrant that I fully understand the contents thereof.

I understand that I may be photographed or videotaped during normal camp activities and these photos/videos may be used in promotional materials.

I am aware of the risks associated with participation in the above mentioned camp and do hereby voluntarily assume full responsibility of any risk of loss, property damage or personal injury, including death, that may result from participation in said camp activities. I acknowledge that I have completely understood this document and all its terms and by checking the box below, I consent to the use of this e-signature and understand that by e-signing I am legally bound to the terms of this document.

I agree to the terms and conditions above.

By Submitting this form, you will complete REGISTRATION.

Camp Mulberry Volunteer Registration 2025

Volunteer Information

Medical Information

Medical Release Statement

Release Statement