Iowa Youth Camp Staff Application

Tell us all about your previous camp staffing experiences

Please read carefully. This Agreement affects your legal rights and is legally binding. By signing this Agreement, you are releasing the United Pentecostal Church International (UPCI), The Iowa District of the UPCI, The Iowa Children’s Ministry of the UPCI, the Iowa Youth Department of the UPCI, and all pastors, ministers, officers, directors, employees, volunteers, agents, representatives, and insurers (hereinafter the “Iowa District”) from all liability and forever giving up any claims thereof.

I acknowledge and agree that there are risks inherent in attendance and participation in the Iowa District camp, which may result in various types of injury or damage, including but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for mine and/or a minor child’s opportunity to attend and/or participate in the Iowa District camp, I, on behalf of myself and/or the minor child, acknowledge and accept the risks associated with participation and attendance. On behalf of myself and/or a minor child, I knowingly accept personal financial responsibility for any injury or other loss sustained during the attendance and participation in the Iowa District camp. I further accept personal financial responsibility for any medical treatment rendered to the participant that is authorized by the Iowa district, its agents, employees, volunteers, or other representatives. Further, I hereby release the Iowa District of all liability for any property damage, injury, loss, illness, or death. I further agree to indemnify, defend, and hold harmless the Iowa District, its employees, leaders, owners, agents, and representatives from any and all causes of action, claims, demands, losses, or costs of any nature arising out of or in any way related to my or the minor child’s attendance or participation in the Iowa District Camp, including but in no way limited to damages or liability from damage to property, bodily injury, personal injury, emotional injury, illness, permanent disability, and/or death, as well as medical expenses and other costs for myself or the minor child.

If a dispute over this Agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process. I certify that I am of lawful age and otherwise legally competent to sign this Agreement. If signing on behalf of a minor child, I affirm and certify that I have the legal capacity to sign on behalf of the minor child. I further certify and affirm that, after an arm’s length negotiation, I am freely signing this Agreement, free from any inducement or representation. I further affirm I have read this Agreement and fully understand that by signing this Agreement, I am giving up legal rights and/or remedies which may be available to myself and/or the minor child regarding any losses I or the minor child may sustain as a result of participation in the Iowa District camp.

The information contained in this application is correct to the best of my knowledge. I authorize any reference or churches listed in the application to provide any information (including opinions) that they may have regarding my character and suitability for youth work. I understand a criminal record check may be conducted as a result of this application. In consideration of the receipt and evaluation of this application by the Iowa District Youth Department, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively or individually, from any and all liability for damages of whatever kind of nature which may at the time result to me, my heirs, my family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. I also understand that my personal insurance (if applicable) is primary coverage and the Youth Camp’s insurance is secondary. I agree to and hereby release from all liability, personal and/or property, and hold harmless the Iowa District U.P.C., its subsidiaries, trustees, employees, agents, sponsors and volunteers from all legal responsibility, including claims, demands and lawsuits resulting from or related to any incidents arising from or connected in any manner with the Iowa District U.P.C. Youth Camp, including, but not limited to, liability, damages and legal fees or costs caused by or related to the negligence or intentional act of the Iowa District U.P.C., its subsidiaries, its trustees, agents, sponsors or volunteers. Should my application be accepted, I agree to be bound by the Bylaws and Youth Camp Policies of the Iowa District United Pentecostal Church, to comply with all Youth Camp Regulations and fulfill my job descriptions given by the Youth Camp Executive Committee and refrain from unscriptural conduct in the performance of my services on behalf of the district, I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.