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TUL WKND Volunteer Registration on Friday, February 5, 2021 @ 5:00 PM

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Please make sure the information above is for the Volunteer ONLY and then complete the additional registration information below! *One Volunteer per registration.

*Date of Birth:
*Which Campus do you attend:
If "Other" was selected in the last question, provide church name.:
*Where would you prefer to serve? 
  Examples: Community Group Leader, Decision Counselor, Meal Service, etc..
*Can you commit to being there for the entire weekend?:
If "No" was selected in the previous question, please explain days and times you are available:
Comments or Request:
*Primary Contact Phone Number:
*Contact Email (All important event information will be sent to this email):
*Emergency Contact First & Last Name *Must be Different than Parent/Guardian:
*Emergency Contact Phone Number:
*Emergency Contact Relationship:
*Please list any medical conditions that we need to be aware of *If none, list N/A:
*Insurance Provider:
*Primary Insurance Holder's First & Last Name:
*Member ID:
Group Number:
*

Medical Release: By signing my name in the box below, I agree that I am the parent or guardian of the participant listed above, or am the participant myself, and am over the age of 18, and agree to the following conditions: I give my consent to BattleCreek Church, including any medical personnel, staff or volunteers participating in TUL Weekend, to administer to the participant any medical treatment, including medication, they deem necessary during the participant's participation at TUL Weekend. I further authorize BattleCreek Church staff and volunteers to obtain for the participant any outside or off-site medical and/or surgical treatment they deem necessary and authorize the treating physician (chosen by BattleCreek Church) and his or her medical staff to carry out any medical and/or surgical treatment in accordance with the treating physician's diagnosis. I understand that I will be notified, as soon as practicable, of any medical treatment administered to the participant and will be responsible for all costs associated with any such medical treatment. I also give BattleCreek staff and volunteers permission to transport the participant to obtain medical treatment or in the event of an emergency. I hereby agree to hold BattleCreek Church, including its representatives, agents, employees and volunteers, free of any and all liability, actions, causes of actions, claims, expenses and damages on account of injury to the participant or property; even injury resulting in death, which may arise in connection with the participant's participation in TUL Weekend or any other associated activities, including the administration of medical treatment.


Medical Release First & Last Name Signature 

*Photo/Video Release: By signing my name in the box below, I agree that I am over the age of 18 and am legally able to give consent for the aforementioned participant. I understand and will allow photos and videos of the participant taken while at TUL Weekend to be used in any of BattleCreek Church’s publications. I also understand that the publication of these photographs may be accomplished electronically via the Internet and that after publication BattleCreek Church will be unable to prevent persons from gaining access to the Internet, copying my photographs and video, and subsequently using, altering, or republishing it without my consent. I waive any claim for damages against BattleCreek Church from unauthorized use, alteration, or republication of photographs and video by third parties accessing the Internet.

Photo/Video First & Last Name Signature