Walking with Jesus Service Camp
Adult Volunteer Registration
Email *
First Name *
Last Name *
Phone Number *
Home Address *
City *
Zip Code *
Please List your work experience that you are comfortable leading. (Check all that Apply) *
Required
Please tell us about your work experience *
What days can you help out ? *
Required
What job site(s) are you interested in helping with? *
Required
I have completed the Safe Environment Training through the Archdiocese of Milwaukee *
Parish that you Completed your Safe Environment training for *
Consent to Participate and Indemnity Agreement
I consent to participate in this activity. I agree to reimburse and indemnify the parish/school (understood to include the Archdiocese of Milwaukee) for all reasonable legal and court fees incurred by parish/school in defending a lawsuit that I may bring against the parish/school which relates to the above named activity if the parish/school is found not legally liable by the courts and prevails in the lawsuit. If the parish/school is found legally liable for injuries sustained by me, this paragraph will not apply. I certify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that I will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish/school to clarify any concerns or questions about the activity or this agreement that I may have had. *
Required
Photo / video consent
I give my consent for the parish and / or the Archdiocese of Milwaukee to use any still or electronic image and / or audio recording in which I may appear. I understand that these materials are being used to promote the “Walking with Jesus Summer Service Camp 2021” in the parish or Archdiocese of Milwaukee. The images and / or recordings may be used to support participation, fundraising, evangelism and / or other propaganda efforts. I allow staff and volunteers to take photo / video; I understand and agree that the use of photo / video is not an invasion of my privacy. Neither I, nor anyone who claims to speak on my behalf, will later object to the Archdiocese using these images and / or recordings. *
Required
Medical Information and Consent
The following information will be used only in the event of an emergency in which you are unable to seek medical attention for yourself.
Physician's Name *
Phone Number *
Name of Health Insurance *
Policy Number *
Special Dietary Needs, Allergies, or Mental/Physical Health Issues We Should know in the Event of an Emergency *
Please list any medication you are currently taking *
Emergency Medical Treatment:
In the event of an emergency, I hereby give permission to be transported to a hospital for emergency medical treatment. I wish to have my spouse/parent advised prior to any further treatment by the hospital or doctor. In the event of emergency, please contact:
Spouse/ Emergency Contact Person Name *
Phone Number *
Ability to Participate *
Required
A copy of your responses will be emailed to the address you provided.
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