Volunteer / Staff Application

General Information

Full Name

School Attending/or Graduating from

Age - How old will you be on June 1, 2024?

Date of Birth

T-Shirt Size

Phone Number

Street Address

City

State

Zipcode

Email (required)

Driver’s License Number

State Issued

Are you a US Citizen?
YesNo

If not, is it legal for you to work in the US?
YesNo

Social Media Accounts

Instagram Account Name

Twitter Account Name

Snapchat Account Name

Tik Tok Name

List any other social media accounts you use

Counseling Details and Personal/Leadership Qualities

Camp Amplify requires all staff members to attend staff training, date & time TBA. Volunteer/Missionary: Not monetarily compensated.

Camp Amplify performs a background check on all Volunteer applicants to ensure the safety of our campers. Do you agree to allowing Camp Amplify to perform a background check?
YesNo

Personal References

Please give your Pastor (or Youth Pastor) and two other non-family references below. We will contact these references as part of your potential service.

Reference Name (1)

Reference Phone Number (1)

Reference Name (2)

Reference Phone Number (2)

Reference Name (3)

Reference Phone Number (3)

Medical Information

I am allergic to the following:

Medications:

Foods:

Other:

Do you have an EPI Pen?
YesNo

Please list any other medication conditions Camp Amplify should be aware of:

Any medication brought to camp must be turned in to the camp nurse and listed in the medications area of your application. If this is not followed, the camp nurse will add these medications to your application. Are you willing to abide by this policy?
YesNo

Name of Insurance Company:

Policy Number:

Insurance Company phone number:

Your doctor's name:

Your doctor's phone number:

Emergency Contact Name:

Emergency Contact Number:

Emergency Contact Relationship:

Please attach a scan or photograph of your drivers license below

Please read the following waiver and release. Below it, you can enter you name if you agree with the terms, and if you verify that all information given is true to the best of your knowledge

Waiver and Release.  Volunteer covenants not to sue and does hereby release, forever discharge, and agree to hold harmless and fully indemnify Camp Amplify Inc. and its affiliates, officers, directors, staff, employees, agents, volunteers, counselors, sponsors, heirs, administrators, successors and assigns (the “Released Parties”), from any and all liability, claims, demands, damages, expenses, and causes of action of whatever kind or nature, either in law or in equity arising out of or relating to (i) Volunteer’s participation in Camp Amplify Inc. events (ii) Volunteer’s performance or non-performance of volunteer work and (iii) first aid or medical treatment provided to Volunteer in connection with his or her participation in events and volunteer work with Camp Amplify Inc. Without limiting the generality of the foregoing, Volunteer understands and acknowledges that the foregoing covenant not to sue, release, discharge, and agreement to hold harmless and fully indemnify discharges the Released Parties from any liability or claim that Volunteer may have against a Released Party for bodily injury or property damage, regardless of whether such injury or damage is caused in part by the act or omission of a Released Party. Notwithstanding the foregoing, nothing in this release shall be interpreted as requiring Volunteer to indemnify, defend, or hold harmless a Released Party from any liability, claims, demands, or causes of action caused solely by that Released Party’s gross negligence or willful misconduct. Volunteer agrees that the release, discharge, and agreement to hold harmless and fully indemnify set forth in this release are intended to be as broad and inclusive as permitted by law.

Assumption of the Risk. Volunteer understands that participating in Camp Amplify Inc. events and his or her volunteer work may involve activities that may be hazardous to the Volunteer and inherently dangerous risks, including but not limited to horseback riding, camp sports or amusement rides, swimming and traveling to and from camp or parks in vans or busses and Volunteer understands that there is a possibility of accidental or other physical injury or death to Volunteer or of loss or damage to Volunteer’s property. Volunteer hereby expressly and specifically assumes the risk of damage, injury, harm, or death in connection with such participation and volunteer work. In addition to any other risks posed by participating in events of Camp Amplify Inc. and his or her volunteer work, Volunteer understands that, despite any safety precautions being taken by Camp Amplify Inc., by participating in events and volunteering with Camp Amplify Inc., there is a risk of potential exposure to COVID-19 or any other harmful virus or bacteria, which may result in illness or death.

Medical Treatment. Volunteer hereby grants permission for first aid and/or C.P.R. to be given to Volunteer in an emergency, as determined in the sole discretion of any employee, staff member, or agent of Camp Amplify Inc.  Volunteer further agrees that (a) Volunteer will be solely responsible for any medical costs or expenses or any loss, liability, or damage which may arise as a result thereof, (b) Camp Amplify Inc. (including its employees, staff members, and agents) may act on Volunteer’s behalf in securing medical treatment for Volunteer in the event of injury or illness to Volunteer, and (c) Camp Amplify Inc. may act on Volunteer’s behalf in accepting financial responsibility for any such first aid and/or other medical treatment secured for Volunteer (which responsibility shall be borne solely by Volunteer).

Photographs and other Media Release. Volunteer agrees to allow Volunteer to be photographed or recorded in other media, such as video or audio recordings, in connection with activities or events of Camp Amplify Inc. Volunteer understands and agrees that the photographs and/or other media recordings may be used to promote Camp Amplify Inc. and/or its services and events. Volunteer hereby irrevocably grants and conveys unto Camp Amplify Inc. all right, title, and interest in any and all photographic images and other media recordings taken of Volunteer during activities and events of Camp Amplify Inc., including, but not limited to, any royalties, proceeds, or other benefits derived from such photographs or other media recordings.  Volunteer understands and agrees that Volunteer is waiving all rights to privacy and ownership regarding the use of such photographs and other media recordings.

Applicant Signature of Release (type your full name):

Parental Signature (if under 18 years)

Δ