Camp Fire Clubs Adult 2019-2020 Registration Form
Email address *
Personal Information
First Name, MI, Last Name *
Phone Number *
Secondary Phone Number
Address (street, city, state, zip) *
Gender *
Former Camp Fire Member? *
Occupation *
Employer *
Employer Address *
Employer Phone *
Hobbies, Interests, Areas of Special Expertise *
Service Clubs and Volunteer Community Activities *
Prior Camp Fire Activities
Education (Diplomas, Degrees, Subject) *
Licenses and Certifications
Emergency Contact
Who should we call in case of an emergency?
Name *
Phone *
Secondary Phone
Address (Street, City, State, Zip) *
Relationship *
Club Information
We just need some basic info...
Area *
Club Program *
Affiliation *
Membership Status *
Membership Fee (membership year 9/1/19-8/31/20)
Clear selection
Our Promise
Young People want to shape the world.

Camp Fire provides the opportunity to find their spark, lift their voice, and discover who they are.

At Camp Fire, it begins NOW.

Light the Fire Within
I accept the challenge of the promise and am adding $______ to my payment to give more youth the chance to benefit from the fun and friendship of Camp Fire Wilani.
This section is optional and will be used for statistical purposes only:
Ethnicity/Race
Clear selection
Disabilities (please specify)
Total # in Family
Clear selection
Household Income
Clear selection
Religious Preference
AGREEMENT
I will assist in observing the rules of the council and I waive any claims against Camp Fire Wilani except from claims of gross negligence or willful acts of the council or its agents that may arise from participation in the activities of Camp Fire Wilani. I understand that reasonable measures will be taken to safeguard the health and safety of all participants and that my emergency contact will be notified as soon as possible in case of any emergency. In the event that he or she cannot be reached in an emergency, I hereby authorize the calling of a physician to provide whatever emergency medical or surgical treatment is necessary. I accept the responsibility of the costs of such medical treatments.

DRIVING: Every adult who will be driving a vehicle transporting youth or conducting Camp Fire Wilani business must present a copy of a current driver's license (both sides) and a copy of liability insurance to Camp Fire WIlani before driving youth.

PHOTOGRAPHIC RELEASE: I consent to the taking and use of any slides, photographs, videotaping of myself during the program for advertising, promotion, publicity, or any other lawful purposes by Camp Fire Wilani now and in the future, whether that use is known to me or unknown. I agree and consent that Camp Fire Wilani may publish, broadcast, copyright for all purposes, the statements and/or pictures taken of me and/or my property for advertising and public relations purposes. I waive the right to inspect or approve the photographs or electronic matter and waive the rights to royalties or other compensation arising from or related to the use of the photographs.

PRODUCT SALES: Adult volunteers with youth are expected to support fundraising efforts of the council.
Electronic Signature
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purpose of validity, enforceability and admissibility.
Signature *
Date *
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