Returning RBC Staff Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

First and Last Name *

Birthdate *

YYYY

Gender *

Female

Male

Cellphone number *

Emergency Contact, Relationship to Individual, Home Phone and Cell Phone.
*

Any medication allergies? If yes, please specify.
*

Yes

Other:

Required

Do you have any food allergies or special dietary needs? If yes, list food restrictions.
*

Yes

Other:

Required

Do you have any of the following: (Check all that apply) In the "other" box please explain any that have been checked.
*

Asthma/breathing disorder

Diabetes

Seizures/epilepsy

Epi-pen

History of major head trauma

Heart problems

Physical limitations/restrictions

Does not apply to me

Other:

Required

Will you be bringing any prescription medications? If yes, please list them in the "other" area.

*If you are bringing any medications to camp they MUST be locked in a vehicle at all times.

Yes

Maybe

Other:

Required

Have you ever participated in, been accused of or convicted, or pleaded guilty or no contest to any abuse or sexual misconduct?
*

Yes

If you answered "yes" to the previous question, please explain.

RURAL BIBLE CRUSADE OF WISCONSIN ACKNOWLEDGEMENT & ASSUMPTION OF RISK WAIVER AND RELEASE: Upon careful reading and consideration I, ____________________ (Volunteer/Staff) recognize that some activities carry the risk of injury.*

Your typed name at the end of this document completes this question.

I understand that my typed name at the end of this document validates as my legal signature.

You hereby attest as follows: By signature below, I acknowledge that I will participate in Rural Bible Crusade of Wisconsin activities, programs, and related events. I understand that participation in these activities, programs, and related events is not without risk. I will release, hold harmless, and indemnify Rural Bible Crusade of Wisconsin, its board, staff, and/or volunteers for any harm, injury, or death caused by my participation with RBC. I understand that no activity program is absolutely safe and free of risk. Rural Bible Crusade of Wisconsin reserves the right to use any pictures taken of me at Camp/Retreats/VBS to promote the ministry.I understand that this is a volunteer/unpaid position. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment or volunteer relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment/volunteer relationship may not be changed by any written document or by conduct unless such changes is specifically acknowledged in writing by an authorized executive of this organization.*

I understand that my typed name at the end of this document validates as my legal signature for this specific segment of the risk waiver.

If I need medical attention while participating, it is my wish that the treatment be begun while efforts are being made to contact my emergency contact. So that treatment is not delayed, I consent to any medical procedures that the Rural Bible Crusade of Wisconsin staff and/or physician believes needed, on the understanding that efforts will continue to be made to contact my emergency contact. I accept responsibility for all cost related to such treatment.
*

I accept responsibility for all cost related to such treatment.

Required

Rural Bible Crusade of Wisconsin also reserves the right to use any pictures taken of you at Camp/Retreats/VBS to promote the ministry.
*

I understand that my typed name at the end of this document validates as my legal signature approving of Rural Bible Crusade of Wisconsin's freedom to take and post pictures of myself to promote their ministry.

My signature at the end of this document verifies that...

*All of these documents/video (Child Protection Policy, Staff Conduct Policy, and Doctrinal Statement, and Keeping Children Safe and Secure Video) may be accessed at http://www.ruralbiblecrusade.org/forms-staff-training/. If you are unable to access them please contact the Rural Bible Crusade of Wisconsin office at jdcrbc@gmail.com or 715-563-4488.

...I have read and agree to follow Rural Bible Crusade of Wisconsin's Child Protection Policy.

...I have read and agree to follow Rural Bible Crusade of Wisconsin's Staff Conduct Policy.

...I have read and agree to Rural Bible Crusade of Wisconsin's Doctrinal Statement and will not teach anything that is controversial to their beliefs.

...Rural Bible Crusade of Wisconsin has permission to do a background check on me.

...I have watched the "Keeping Children Safe and Secure" video.

Required

I have had sufficient opportunity to read this entire document and other documents/video listed above. I have read/watched and understood them, and agree to be bound by the terms.*

By typing your name you are signing your legal electronic signature and are thus agreeing to be bound and abide by Rural Bible Crusade of Wisconsin's terms and conditions. This signature is valid for the entirety of this document.

Option 1

Other:

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms