EKO Camp (Counselor/Young Adult Registration)

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Camp Counselor/Jr. Leader/Young Adult 
Registration Form Sept. 30-Oct. 2, 2011

Under the provisions of the Volunteer Immunity Act, I agree to hold harmless Every Kid Outreach, Inc., (EKO), its’ staff, volunteers, and private providers (i.e. The Life Center Church, Lakeside Alternatives, Mears Transportation, The Experience Christian Center and Younglife at Southwind). This immunity will also include travel.

I authorize EKO, its’ staff, and volunteers to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered under the general or special supervision and on the advice of any physician or dentist licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.

I give to be interviewed, photographed, videotaped or used for any pictorial representation for EKO purposes.
    
   


* indicates required fields 
  *Name:
  *Address:
  *Phone Number:
  *Email Address:
  *Gender:  Male
 Female
  *Paid for Camp?:  Yes
 No
  *If yes, date and method of payment:
  *Do you have any youth ministry experience?:  Yes
 No
  *If yes, please explain.:
  *List any skills/certifications you have:
  *What group would you like to serve?:  Middle
 High
 No preference
  *Briefly explain why you want to be a counselor::


**If you need addition space to explain why you want to be a counsellor, please fax additional sheet(s) to EKO at 407-628-7205**

$50.00 Counselor/Young Adult (19-21 years old) **Attach additional sheet(s) if necessary**

Please register no later than Friday, September 2, 2011
 


Every Kid Outreach, Inc.
63 East Kennedy Blvd.
Eatonville, FL 32751
TEL:  407-629-4507  |  FAX: 407-628-7205

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