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) *
Please tell us about your work experience *
What days can you help out ? *
What job site(s) are you interested in helping with? *
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. *
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. *
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 *
A copy of your responses will be emailed to the address you provided.
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