Clone of Delegate Application

Basic Information
Auto-Generated ID
Application ID
Name

First NameLast Name
Nickname
Do you go by another name?
Gender
Shirt Size
Current Photo of Yourself

Cancelof
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Marital Status
Do you have children?
How many children?

Experience
Order Affiliation
How many years?
Youth Work (Order Related)
Youth Work (Other)
Other Related Activities and Interests
Current Occupation
Skills that may be helpful to the Program (music, drama, etc.)
Any other information you'd like to share?
Do you smoke?
Are you capable of doing a lot of walking/climbing?
Will you cooperate with leaders of the program and other adult co-workers?
Will you refrain from use of alcohol, illegal drugs, tobacco, and offensive lagnauge/behavior while serving as a tour leader (24 hours/day)?

Insurance Information
Name of Health Plan Provider
Policy #
Insurance Company Name
Insurance Company Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Policy Holder Name
Relationship

Emergency Contacts
Emergency Contact #1
Name
Relationship
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact #2
Name
Relationship
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

Required Forms
In order to complete your application, IOOF Pilgrimage for Youth requires an additional form to be filled out by hand to protect the validility and authenticity of the form.
- One (1) Medical Release and Waiver completed and signed by a physician.
The form can be accessed below:

Medical Release and Waiver Click Here to Download

Upon submitting your application, you will be emailed an additional link that can be used to upload these forms once they are filled out.

Dietary Information
Does the Applicant require special meals for health or religious reasons.
Please explain the Applicant's special meal requirements.
Does the Applicant have any food allergies?
Please list the Applicant's Food Allergies.

Agreements & Signature Page
Privacy Statement
The information contained in this form is used by management of the program to select and administer the program. Except in case of medical emergency, information will not be disclosed to third parties. In the case of medical emergency, information may be released to attending medical personnel. Furnishing this information is voluntary, but failure to do so may prohibit participation in the Program.
Consent & Release
I hereby authorize The Independent Order of Odd Fellows Pilgrimage for Youth Inc. to photograph and/or videotape me or contract to do so and to publish or broadcast such photograph(s) or video(s) of me through various media, including the Internet or multimedia products.

I understand and agree that The Independent Order of Odd Fellows Pilgrimage for Youth Inc. or its agents are not responsible for the misuse or alteration of any such photographs and/or videotapes by third parties.

I hereby release The Independent Order of Odd Fellows Pilgrimage for Youth Inc. and any of its officers, agents, employees or servants from any and all actions, claims, loss or causes of action arising from the use or misuse of such images.
Rules & Regulations
The Independent Order of Odd Fellows Pilgrimage for Youth program has been in existence since 1949. During this time, certain rules and regulations have been adopted to ensure the safety and enjoyment of all participants. These rules include, but are not limited to, mandatory curfew, no activities which might cause destruction of property, no alcohol, illegal drugs, tobacco or offensive language/behavior.

It is important that while every consideration will be given, should the Applicant disregard any rules or regulations he/she will be sent home at their own expense.
I have read this Tour Leader Application in its entirety and understand that, if selected, a background check will be ordered.
Applicant Signature
The Odd Fellows and Rebekahs Pilgrimage for Youth Inc. will not discriminate against any individual on the basis of disability, ethnicity, gender, race, sexual orientation, religion or other social identity from the full and equal enjoyment of its services, unless the individual possesses a direct threat to the health and safety of others, or him/herself, that cannot be eliminated by a modification of policies, practices, or procedures by the provision of auxiliary aids or services, nor exclude any individual because of the individual’s association with a person of disability, ethnicity, gender, race, sexual orientation, religion or other social identity.
Should be Empty:

Basic Information

Experience

Insurance Information

Emergency Contacts

Emergency Contact #1

Emergency Contact #2

Required Forms

Dietary Information

Agreements & Signature Page

Privacy Statement

Consent & Release

Rules & Regulations