JDOK Saturday Volunteer Registration 2023

Name

Address

Email and our Google Group will be our main forms of communication.

This address will receive a confirmation email

Phone

T-Shirt Size

AS AM AL AXL A2XL A3XL

Emergency Contact

Relationship

Emergency Contact's Phone

Are you current with Safeguarding God's Children?

Yes I do not know

Safeguarding expiration date:

Known Allergies & Reaction(s) (if none, please put N/A)

Please list any dietary restrictions/allergies (if none, please put N/A)

Other pertinent medical information (if none, please put N/A)

I confirm that I am healthy and capable of participating in this event. I also confirm that I am covered by medical insurance, or if medical insurance is not available to me, I agree to be personally responsible for the costs of any medical treatment deemed necessary. I hereby release, relieve, indemnify, and hold harmless the Junior Daughters of the King, the Daughters of the King, Camp Allen and its employees, the driver of the transport vehicle, the Episcopal Diocese of Texas and its bishops, clergy, event coordinators, youth leaders, employees, representatives and agents from any and all liability for any injury, illness or property damage associated with my participation in this activity or travel associated with this event. In the event that I should require medical treatment and I am not capable to give consent for such treatment, by signing below, I hereby give consent to such treatment. The sponsors of this event do NOT provide insurance in case of injury or illness. I understand that photos or videos of myself and others may be taken during the event, and I consent to the use of my photo or likeness by Junior Daughters of the King in promotional materials. I acknowledge/confirm that the information listed on my application is true and accurate.

Yes No

When would you like to serve?

Morning 9:00 AM-2:00 PM 1:30 PM-7:00 PM

Optional Donation (please select one of the options from the drop-down menu):

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

JDOK Saturday Volunteer Registration 2023

Description

Please Fix the Following