Junior Volunteer SuperKids Summer Day Camps Application 2022

APPLICANT'S INFORMATION

Applicant's First & Last Name (required)

Applicant's Email Address (if applicable)

Applicant's Cell Number (if applicable)

Upload a photo of the applicant (5mb limit) (required)

Gender (required)
MaleFemale

Street address (required)

City (required)

Province (required)

Postal Code (required)

D.O.B (YYYY-MM-DD) (required)

Height (ft and in) (required)

Weight (lbs) (required)

Age (required)
14151617

T-Shirt Size (required)
Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-Large

CONTACT INFORMATION

Parent/Guardian First & Last Name (required)


Phone Number (required)


Email address (required)


Emergency Contact #1 Full Name (first and last) (required)


Phone Number (required)


Emergency Contact #2 Full Name (first and last) (required)


Phone Number (required)


SERVICE DETAILS

We will be with kids aged 6 to 13 at the SuperKids Summer Day Camps and outside during the camps. We will be providing lunch, snacks, and drinks. We highly recommend bringing your own water bottle too. Please note the dates and times listed on the program page.

Please indicate which week(s) you will be available to volunteer with us.
July 13-15July 20-22Both

Do you have any experience working with kids? If so, please describe below.


IMPORTANT NOTE: If you would like to join us for SuperKids Summer Day Camps, please ensure that you notify your employer ASAP so that they have ample time to plan for covering your shifts. Thank you!

REFERENCES

Reference 1

Full Name (required)


Work Reference or Personal? (required)


Phone # (required)


Email (required)


Reference 2

Full Name


Work Reference or Personal?


Phone #


Email


APPLICANT'S STATEMENT

• A youth (ages 0-17): I agree to adhere to the Child Protection Policy as adopted by Extreme Outreach Society. Waiver Statement: "I understand that this information will be held in strict confidence by the administrative employees of Extreme Outreach and that it will not be released without the permission of the applicant, except when such disclosure is required by law. I understand that I am prohibited from publishing or publicizing photos of any and all SuperKids."

I understand & agree

HEALTH FORM

I give Extreme Outreach staff/volunteers permission to seek out all necessary medical advice and attention in the event of an emergency.

BC Care Card # (required)


Doctor's Name (required)


Doctor's Phone # (required)


Allergies & Symptoms (list reaction(s) if any)


Dietary needs or restrictions


List all medications you take between 10 and 3 *Epi Pen must be brought if needed* (one per line)


Other health notes for us to be aware of


Do you grant the designated leader permission to give over the counter medications if necessary?
YesNo

LIABILITY WAIVER AND MEDICAL RELEASE (PLEASE READ CAREFULLY)

Assumption of Risk Form - Volunteer:

I am/will be a Volunteer of the Extreme Outreach Society of British Columbia, having a head office in Victoria, British Columbia, warranty and represent and agree that:

1. I am a volunteer worker and not an employee or independent contractor of the Extreme Outreach Society of British Columbia.

2. I am aware of the hazards and risks to my person and property associated with serving in a volunteer outreach mission worker capacity with the Extreme Outreach Society of British Columbia (hereinafter referred to as “EOS”) in the different social situations I may be asked to serve and have inquired into the possible difficult and/or dangerous situations I may find myself as a result.

3. I am aware, as a result, that such hazards and risks include, but are not limited to, death or injury by accident, disease, war, terrorist acts, weather conditions, inadequate medical supplies and services, criminal activity, and random acts of violence.

4. I understand that Extreme Outreach Society is not responsible for lost, stolen, or damaged items during my participation in the outreach.

5. I accept my assignment as a volunteer outreach mission worker with EOS with full awareness of these risks, and, subject to any insurance coverage that may be available to me from any source, and I voluntarily assume all risks of death, injury, and illness associated with such risks, and any damage to my personal property, and I release EOS, and its agents, officers, directors, employees and volunteers from any liability whatever arising as a result of death, injury, or illness that I may suffer as a result of my participation in any volunteer EOS missions outreach or endeavour. I further recognize that such risks have always been associated with missionary service.

6. I certify to the best of my knowledge, I am physically fit and have no medical condition that would in any material way, interfere or prevent me from performing my reasonable duties as a volunteer outreach mission worker under the auspices of EOS.

7. I expressly waive any defence to the enforcement of any provision of this commitment arising from a claim of lack of consideration and warrant that this constitutes, and binding obligation upon me enforceable against me in accordance of its terms.

8. I acknowledge that a representative of EOS has recommended that I obtain independent legal advice from a lawyer of my own choice as to the validity and substance of the terms of this release and, for reasons of my own decision have: decided not to obtain such legal advice; or decided to consult a lawyer of my own choice.

9. I am aware of the hazards and risks to my person associated with participation in EOS as a volunteer outreach mission worker, as described above. I further understand that EOS may not have any insurance coverage that would apply in the event of my death, illness, injury, or damage to my property that may occur during my participation as a volunteer outreach mission worker with EOS and that if I desire insurance coverage I am responsible for the cost of such insurance.

10. I expressly agree that this Assumption of Risk and Release Agreement is intended to be as broad and inclusive as permitted by law. I further state that I HAVE CAREFULLY READ THE FOREGOING ASSUMPTION OF RISK RELEASE AND INDEMNITY FORM AND UNDERSTAND ITS CONTEXTS, AND I VOLUNTARILY SIGN THIS ASSUMPTION OF RISK RELEASE AND INDEMNITY FORM AS MY OWN FREE ACT. THIS IS A LEGAL DOCUMENT AND I UNDERSTAND THAT I HAVE THE OPPORTUNITY TO CONSULT WITH AN ATTORNEY BEFORE SIGNING IT.

11. I am confident that Extreme Outreach Society staff will do their best to offer necessary support and supervision and I understand that the safety and health rules will be observed.

12. The Program Director reserves the right to dismiss myself/my child, who in their opinion is a hazard to the safety and the rights of others, or who appears to have rejected the reasonable expectations of the program. Extreme Outreach Society staff/volunteers will do their best to give myself/my child the necessary support and supervision needed and I understand that the safety and health rules will be observed.

13. I give Extreme Outreach staff/volunteers permission to transport myself/my child via vehicle to and from the pick-up location to the program location. I hereby release Extreme Outreach Society and its staff/volunteers from all claims and damages arising from any accidents or injury caused by my/my child’s participation in the program or by transportation to and from pick-up location and program events.

14. Signing this form gives permission for reasonable photographs or videos of program activities which may include myself/my child to be used in reasonable program promotional materials, brochures and/or placed on a program photo CD.

15. MEDICAL RELEASE - PLEASE READ THE BELOW INFORMATION CAREFULLY:
To the best of my knowledge, I am (my child is) in good health and physically, emotionally, and socially able to participate in all activities. In case of a medical emergency, I understand that every effort will be made to contact the emergency contact or parents/guardians. In the event that they cannot be reached, I hereby give permission to transport myself/child as named above to medical aid. Also, I hereby give permission to the physician selected by Extreme Outreach to secure proper treatment for myself/child as named above. In the event extraordinary transportation or medical treatment is required, I agree to accept financial responsibility in excess of the benefits allowed by provincial health and medical insurance.

To indicate your understanding of the above, place a checkmark in the box below and provide your full name and date:

I understand & agree

Full Name of Applicant


Full Name of Parent or Guardian


Date Signed