Coach / Volunteer Registration - School Year Events

POLICIES; HEALTH RELEASE; MEDIA RELEASE

Please carefully read each statement below. You'll be asked to initial each section using your mouse or touch screen, and to sign and date the document before you Submit.

Medication at the Event

Prior to event, you will receive a medication form. You will be able to provide specific details on how and when to administer medication. The policy regarding medication is as follows: • Keep all medication in its original pharmacy labeled bottle or its original over-the-counter packaging. The medical staff will not dispense any medications not in its original container. This policy includes vitamins and herbs. • Place medication bottle or original over-the-counter package in a labeled Ziploc bag. • Include the medication form in the Ziploc bag with the medication you'll need. • Bring your medication with the form to the event.

Cell Phone

Cell phones are not allowed during the event except for emergency situations. During the event your focus should be on your Champion. Using a cell phone will hinder your opportunity to develop a relationship with him or her. Please do not share your cell phone number with your Champion. Difficult situations can arise if your Champion begins to call you repeatedly. If asked, simply say that it is not a good idea to share cell phone numbers.

Attire

Please wear appropriate clothes for the season of year and the nature of the activity. If wearing shorts, please make sure they are modest length. Please do not wear flip-flops; tennis shoes or secure sandals like Charco's are required.

Training

When you are accepted, we'll give you Training dates and times. if you are unable to attend Training, please notify Alison Gromer (alison @ ChampionsSpecialMinistries.org). Schedules and other information that will help prepare you in your volunteer role will be given to you at training time.

Volunteer Hours

Participation in the Champions program can be used for volunteer service hours.Champions Special Ministries will provide a certificate of service at the end of the program if you request it.

Policies - Initial*

I have carefully read and understand the above Champions Special Ministries Inc. policies. I agree with the policies and will inform my camper of the rules and policies of camp. (Initial using your mouse or touchscreen.)

Release of Liability - Initial*

I understand that Champions Special Ministries Inc. is NOT responsible for loss of clothing or personal property while at events. I agree to bring all articles of clothing and personal property clearly marked with my first and last name. I understand that part of the day camp experience involves activities, group social arrangements and interactions. These activities and interactions may come with certain risks or uncertainties, and I am aware of these risks. I realize that no environment is risk-free, and I understand risks are minimized when following the rules as instructed by the camp staff. These rules are made to insure safety for all and I agree to follow all rules. I hereby, and for my heirs, executors, and administrators, assigns and all legal guardians, waive and release any and all rights and claims of any nature I may have against Champions Special Ministries Inc., its directors, collectively and individually, employees, Board of Directors, coaches, campers and cooperating entities for and against any and all injuries and damages of any nature, including death, which I may suffer while taking part in Champions Special Ministries Inc. Day Camp or other activities associated with Champions Special Ministries Inc. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE CHAMPIONS SPECIAL MINISTRIES, INC., RELEASE OF LIABILITIES. (Initial using your mouse or touchscreen.)

Medical Authorization and Privacy Agreement - Initial*

I hereby give permission to the physician selected by the Camp Director to order routine medical tests, X-rays, and treatment for emergency health concerns in the event that the parent/guardian cannot be reached. I give the members of the camp medical team permission to administer over-the-counter medications as needed and to give scheduled medication as ordered on the Medication Instruction Form. I realize the camp has a limited liability medical policy for volunteers with a $2,500 maximum limit, covering only trauma, not illness. Any medical expenses in excess of this amount will be my responsibility. I authorize any physician, nurse or other health care provider to communicate with the camp medical staff and any Director of Champions Special Ministries, or his/her designee, concerning my medical condition, treatment and/or prognosis. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE CHAMPIONS SPECIAL MINISTRIES, INC., MEDICAL AUTHORIZATION AND PRIVACY AGREEMENT. (Initial using your mouse or touchscreen.)

Media Release - Initial*

I realize that photographs and films of camp activities may be taken and used for fund-raising and publicity purposes. I hereby give my consent to Champions Special Ministries Inc., its officers, employees, agents, chapters, assignees, licensees and cooperating entities, to use my picture, name, portrait, likeness, writings or biographical information, and/or audio tape for editorial, educational, promotional and advertising purposes, for the solicitation of contributions and for any other purposes in furtherance of the corporate purposes and objectives of Champions Special Ministries, Inc. This release and consent shall be binding upon my child’s heirs, executors, administrator, assigns, and all legal guardians of my child. I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH THE CHAMPIONS SPECIAL MINISTRIES, INC., MEDIA RELEASE. (Initial using your mouse or touchscreen.)

Authorization for Background Check (required for Volunteer Staff over 18)

INFORMATIONAL: All volunteers age 18 and older on the date of the school year program event must complete a separate Background Check Release, authorizing the investigation of any or all statements provided during the process of this application, releasing the organization from all liability for any damages for issuing this information concerning my background. You'll also authorize the investigation of any or all statements provided during the process of this application, and release the organization from all liability for any damages for issuing this information concerning my background records. It's your responsibility to access and complete the Background Check Release form on the Champions web site - - on the menu under School Year Programs

Parent/Guardian's Full Signature and Date*

I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH ALL POLICIES AND STATEMENTS IN THIS CHAMPIONS SPECIAL MINISTRIES, INC., VOLUNTEER REGISTRATION FORM. (Add your signature below with your mouse or touchscreen.)

Volunteer's Full Signature*

I HAVE CAREFULLY READ, UNDERSTAND AND AGREE WITH ALL POLICIES AND STATEMENTS IN THIS CHAMPIONS SPECIAL MINISTRIES, INC., VOLUNTEER REGISTRATION FORM. (Add your signature below with your mouse or touchscreen.)

Today's Date*

(Legal Signature requires you to choose today's date.)

Coach/Volunteer Staff 18 and older*

This $20 fee is for your Background Check form. It's your responsibility to complete the Background Check Release form; see the web site under the Serve page.

Price: $20.00

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Coach/Volunteer Registration Form - School Year Events - 2018-19

COACH/VOLUNTEER INFORMATION:

HEALTH AND INSURANCE INFORMATION:

PERSONAL INFORMATION