Student Volunteer Registration Form Student Volunteer Form - Camps at Port ChurchPlease enable JavaScript in your browser to complete this form.Student Volunteer Name *FirstLast Date Of Birth (YY/MM/DD) *Health Card Number *School I currently attend *Grade as of September 2023 *Cell Phone NumberParent(s)/Guardian name *Home Address *Address 1Address 2Address 2City *CityProvince *ProvincePostal Code *Postal CodeCountry *CountryEmail * Emergency Contact Name * Emergency Contact Phone Number *Please list any previous experience with camps or working with children or type "NONE" *Volunteer Hours/Days for the week of July 17-21 *Please state the days and times you are able to volunteer. Ex. Monday 8:30-4 and Thursday 8:30-12:30. NOTE: lunch is provided for students that give an entire day.Volunteer Hours/Days for the week of August 8-11 2023 *Please state the days and times you are able to volunteer. Ex. Monday 8:30-4 and Thursday 8:30-12:30. NOTE: lunch is provided for students that give a full day. Medical Information *YES, I have medical information to submit (Please make sure to email camp@portchurch.ca)NO, there is no medical information to shareIf you have a Medical Condition(s) e.g. Asthma, Allergies, then please email camp@portchurch.caMedia Consent *YesNoI agree that photographs and/or videos may be taken of me at Port Church programs and events, and may be used in the promotion of Port Church. They may be published or used for any application in newspapers, videos, posters, slide presentations, FaceBook, YouTube, other social media and networking sites or otherwise displayed to the public—either in whole or in part by Port Church. Release and Waiver of Liability *Yes, I agreeNo, I do not AgreeIn consideration of me being permitted to enter the Port Church property, and being permitted to participate in Port Church activities and events, AGREE TO WAIVE, RELEASE, DISCHARGE AND COVENANTS NOT TO SUE, its employees, officers, directors, servants and agents from all liability to myself, or any personal representative of either, assigns, heirs, and next of kin, for any and all claims for damages, for death, personal injury or property damage, suffered by me while participating in any Port Church event or activity. I/WE UNDERSTAND THAT THIS RELEASE AND WAIVER OF LIABILITY applies to any claims occurring from injury to person or property, whether caused by negligence of Port Church or otherwise. I/We acknowledge that the intent of this RELEASE AND WAIVER OF LIABILITY is to prevent Port Church from being held liable for injuries to person or property, and that selecting YES constitutes my/our agreement, not to hold Port Church responsible for any damages, losses, injuries to person or property, as a result of any negligence or other wrongful conduct on the part of Port Church or on the part of other third parties. I/We ALSO AGREE TO INDEMNIFY AND HOLD HARMLESS Port Church from any loss, liability, damage, or cost that Port Church may incur due to the presence of myself upon Port Church premises or in any way using any of Port Church facilities or attending any events of Port Church, whether caused by negligence of Port Church or myself or otherwise. FURTHER, I EXPRESSLY AGREE THAT THIS RELEASE AND WAIVER OF LIABILITY is intended to be as broad and inclusive as is permitted by the law in the Province of Ontario. I/We further agree that this Release and Waiver of Liability shall be valid for the program season or year. I/We have read and voluntarily agree, and further acknowledge that no oral representations, statements, or inducements apart from the written agreement have been made.Injury / Illness Waiver *Yes, I agreeNo, I do not agreeI understand that I am attending a sports camp, and, as such, the space provided will be used by other children and staff and volunteers which can result in exposure to illness from infectious diseases including, but not limited to MRSA, influenza, and COVID-19. Although every effort will be made to enforce Ontario’s Health and Safety Procedures, I realize the potential for exposure still remains. I release the PORT Church staff, volunteers, and board of directors from any liability, loss, cost, damage or medical expense from personal injury or illness that may arise out of activities on the church property. While every effort will be made to ensure everyone's safety, I will not hold PORT Church liable for any accident or illness or other event that may occur.PRINT BEFORE SUBMITTINGIf desired, please print a copy for your records before hitting the register button! Register