Rural Bible Crusade of Wisconsin - Returning Staff Agreement Form
If you have NOT completed the Rural Bible Crusade of Wisconsin Staff Agreement and Health Form within the last two years or your health insurance has changed, please complete here :
. If you HAVE completed the Staff Agreement and Health Form within the last two years please submit the Returning Staff Agreement Form. For example: if you completed the Rural Bible Crusade of Wisconsin Staff Agreement and Health Form in 2016, then it is valid through 2018, but must be resubmitted in 2019.
Name (First and Last)
Have any of the following changed since you submitted the Rural Bible Crusade of Wisconsin's Staff Agreement and Health Form? Check all that HAVE changed.
If any HAVE changed, please type the new information under "other". For insurance, please list: Insurance Company, Phone number, Address, City, State, Zip, Policy Holder Name, Date of Birth, Relationship to Staff, Policy Number, and Group Number
Cell Phone Number
Special Dietary Needs
None of this information has changed since I last submitted the Rural Bible Crusade of Wisconsin Staff Agreement and Health Form
Emergency Name, Relationship to Individual, Home Phone, Cell Phone, and Work Phone (Please specify)
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.
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 cause 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.
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.
My signature at the end of this document verifies that I have reviewed the...
All of these documents can be reviewed here:
. If you are unable to view any of the following please contact the RBC office at
or call 715-384-4944
...Rural Bible Crusade of Wisconsin's Child Protection Policy.
...Rural Bible Crusade of Wisconsin's Staff Conduct Policy.
...Rural Bible Crusade of Wisconsin's Doctrinal Statement and will not teach anything that is controversial to their beliefs.
..."Keeping Children Safe and Secure" video.
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.
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