Summer Camp Leader Application
This registration page is your first step to becoming an adult leader at FBCH Students Summer Camp! Thank you for your interest in serving with us, we cannot do camp without you!Upon completion of this form, you will receive a confirmation email with your next steps to become an official FBCH Students Summer Camp leader. If you have any problems or questions about this form, please feel free to email Chris West at Chris@fbchayden.com.
LEADER INFO
Name
*
First Name
Last Name
Cell Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Male
Female
Birth Date
*
-
Month
-
Day
Year
Date
Shirt Size
*
S
M
L
XL
XXL
Co-Leader Request (Leaders under 21 will be paired with a leader who is 21 or older)
*
At camp, I feel most appreciated and cared for when...
*
Do you have any special medical conditions of which we should be aware?(allergies, diabetic, chronic back pain, panic attacks, anxiety, etc.)
*
Yes
No
Do you require a vegetarian alternative or special diet for meals?
*
Yes
No
RELEASE FORMS
Assumption of Risk
I understand that recreational activities have unforeseen hazards and that participation in the Activity, including travel to and from the Activity, includes certain inherent risks, known and unknown, that cannot be eliminated regardless of the care taken to avoid injuries or losses. The specific risks vary, but may involve property damage, bodily injury, emotional injury, personal injury, death, and financial damage. I understand the risks that are involved in my participation in the Activity. I agree that I assume any and all risks of injury or harm that I may sustain as a result of my participation in the Activity, including but not limited to those risks listed above.
I agree to these terms
*
Yes
Waiver of Liability
To the fullest extent permitted by law, I agree to hold harmless not liable, to not sue, and to release and discharge the First Baptist Church of Hayden, AL, and its agents, representatives, trustees, elders, officers, affiliates, subsidiaries, divisions, administrators, directors, employees, independent contractors, and volunteers (collectively referred to herein as the “Church”) and the promoter, participants, owners, and lessees of the premises at which the Activity is located, and each of their agents, representatives, trustees, officers, affiliates, subsidiaries, divisions, administrators, directors, employees, independent contractors, and volunteers (collectively referred to herein as the “Premises Entities”) on account of or in connection with any claims, losses, demands causes of action, losses, costs, or expenses for any accident or injury or harm of any kind, regardless of cause or fault, as a result of my participation in the Activity. This release is intended to discharge the Church and Premises Entities from any and all liability whatsoever arising out of or connected in any way with the Activity even though that liability may arise out of the negligence or carelessness on the part of the Church or any of the Premises Entities.
I agree to these terms
*
Yes
Indemnification
I agree to defend, indemnify, and hold the Church and the Premises Entities harmless from and against all claims, demands, causes of action, suits, damages, costs, losses, expenses, injuries, losses, damages, and liabilities of every kind and nature as a result of, arising out of, associated with, or resulting directly or indirectly from my participation in the Activity. This indemnification includes, but is not limited to all amounts incurred by the Church or the Premises Entities for defending any such all claims, suits, damages, costs, losses and expenses, including all attorney’s fees and costs incurred. The indemnity shall apply regardless of any active and/or passive negligent act or omission of the Church or Premises Entities, or other responsible party, or their agents or employees.
I agree to these terms
*
Yes
Photo/Video Release
During the above-described activity, photographs may be taken and videos may be produced and used for future publicity. I give permission for images of myself captured during the Activity, including but not limited to images captured by video, photo, and digital camera to be used for the purposes of the Church, including in promotional materials and publications and agree to waive any rights of compensation or ownership.
I agree to these terms
*
Yes
Authorization and Consent to Medical Treatment
I certify that I may receive medical care and dental care pursuant to XXXXXXXX section XXXXXX. I further certify that that I am medically fit to participate in the Activity. In the event that I am injured any time during my participation in the Activity, I hereby authorize and consent for the Church to administer general first aid treatment for any minor injuries or illnesses I may experience. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Church to summon any and all professional emergency personnel to attend, transport, and treat me, and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state or country in which such treatment is rendered. I understand that this authorization and consent is given in advance of any specific diagnosis, treatment or hospital care which may become required, but is given to provide authority and power to the Church to render care in the best judgment of the Church upon the advice of any such medical, dental, or emergency personnel. I understand that efforts shall be made to obtain my consent prior to rendering treatment, but that treatment will not be withheld if I am incapacitated, unavailable, or otherwise unable to provide consent. This authorization is given pursuant to XXXXXXXXXX Section XXXXXXX, and authorization is hereby given to any medical, dental, or emergency personnel who have provided treatment to me. I acknowledge and understand that the Church does not provide medical, or dental insurance coverage for me in connection with my participation in the Activity and I agree to assume all responsibility for payment for any treatment I may receive.
I agree to these terms
*
Yes
Emergency Contact
In the event of an emergency at FBCH Students Summer Camp, who should we contact?
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship
*
Any Questions? Email Chris at Chris@fbchayden.com We are so thankful for you!
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