Volunteer Registration

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Christ the Savior Lutheran Church

Location

10500 E. 126th Street

Fishers, IN 46038

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Contact Robin Patras:

317-842-5649

rpatras@christthesavior.org

Tell us about yourself:

What positions are you interested in?

At least one choice is required.

First Name

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Last Name

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Please check a box below to indicate if you are an adult volunteer or the grade you will be entering in the fall of 2023 if you are a youth volunteer.

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All communication is through email. Youth Volunteers should list parent email as primary and may include student email as optional second email. Adult volunteers enter your email as primary.

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Student/Secondary Email

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Please list adult volunteer phone number or parent phone number for a youth volunteer

Phone

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Emergency Contact Name

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Emergency Contact Phone

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Please indicate below the Days you can Serve. Crew Leaders and Junior Crew Leaders are expected to Serve all 5 Days. For adults who would like to serve for fewer days and have flexibility, you can put the number of days (i.e. any 2).

M, T, W, Th, F or All

Availability

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Allergies, Medical Concerns & Special Considerations
Please give us all pertinent information that will help us to provide a safe environment and positive experience for your child. Include severe allergies that may require medical attention, food allergies, reactions, diagnoses, learning differences and any other information to assist us in caring for your child. We respect your child's and family's right to privacy. This information will only be sharedon a "need to know" basiswith those directly caring for your child. Please contact the Director of Children's Ministry to discuss any concerns or special accommodations that may be needed for your child. If there are none, enter none in the box.

Allergies

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Medical Concerns

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Releases

A medical release is required for all youth volunteers. Adults are not required to have a medical release.
All volunteers are required to have a signed media release and a general release.

CHILD MEDICAL RELEASE FORM

In consideration for allowing the student named above (the “child”) to participate in any of the programs of Christ the Savior Lutheran Church, Inc., an Indiana nonprofit corporation (“CTS”), I/we expressly give CTS, its members, pastors, ministerial staff, officers, council members, agents, employees, and volunteers (hereinafter collectively or individually the “Church”) permission to provide first aid, perform any life-saving procedures, and seek whatever medical attention, treatment, or diagnosis is deemed necessary for the child while the child is participating in any Church program, activity, or event or while the child is on Church property. I/we release the Church and hold the Church harmless from any liability or responsibility for any damage or personal injury to the child, including death, relating to or arising in any way out of the efforts of the Church to provide the child first aid or life-saving procedures or in seeking medical attention to, for, or on behalf of the child, whether such efforts were performed negligently or not performed at all. I/we the undersigned are either a parent of or have legal custody of the child. In the event that the child is injured, ill, or otherwise requires the attention or treatment of a physician or other licensed health professional, I/we consent to any reasonable medical treatment to the child as deemed necessary by such licensed physician or other qualified, licensed health professional. I/we agree to release and hold the Church harmless from any claims, loss, liability, damage, or personal injury, including death, arising from or relating to the Church’s actions in arranging any such medical treatment or recommending any such physician or health professional. I/We also acknowledge that I/we will be ultimately responsible for the cost of any medical care for the child and hold the Church harmless of any such cost or expense. Further, I/we affirm that the health insurance information provided on this form is accurate at this date and will, to the best of my/our knowledge, remain in force for the child. I/we also agree to bring the child home at my/our own expense should the child become ill or if deemed necessary by the Church.

Typing in my name below serves as my signature and that I have read and agree to the Medical Release Agreement as stated above for my child or I am the Adult Volunteer

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GENERAL RELEASE AND HOLD HARMLESS

I/We understand that there are inherent risks involved in any program, activity, or event, including but not limited to property damage, personal injury, or death. In consideration allowing the child to participate in any of the programs of the Church, I/we waive and relinquish all claims that I/we may have personally or on behalf of the child against Church, for death, illness, injuries or damages, personal or property, as a result of participating in any program, activity, or event of the Church or conducted at Church property. As consideration for the child being permitted to participate in any program, activity, or event of the Church or on Church property, I/we hereby agree that neither I/we, nor any of my/our heirs, assigns, personal or legal representatives, or family members will bring suit or make a claim for death, illness, injuries, or damages, personal or property, resulting from or relating to the negligence (but not the willful misconduct) of the Church. I/we hereby release the Church from and against any and all liability arising out of, relating to, or in any way connected with, the child’s participation in any program, activity, or event of the Church or on Church property, including any liability for negligence (but not willful misconduct) of the Church. I further agree to indemnify, defend, and hold the Church harmless from any and all claims resulting from injuries – including death, illness, damages, property damage, or loss – sustained by the child arising out of, connected with, or relating in any way with any program, activity, or event of the Church or on Church proper.

Typing in my name below serves as my signature and that I have read and agree to the General Release and Hold Harmless Agreement as stated above.

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MEDIA RELEASE

I hereby grant Christ the Savior Lutheran Church, Inc. (“CTS”), and its officers, directors, pastors, ministry staff, members, and volunteers, and any photographer and videographer retained or hired by CTS (the “Grantees”) the right to film, photograph, and quote my minor child and to use my child’s voice, likeness, photograph, image, distinctive appearance, gestures, or mannerisms, including but not limited to, any and all photographs or reproductions, videotapes, sound recordings, digital recordings, and other audio-visual electronic materials created by Grantees (the “Property”). This grant includes the right to modify or retouch the Property as any Grantee deems appropriate and to use and employ words, symbols, designs, or copy in conjunction with the Property. I understand that the Grantees are the exclusive owners of all rights, title, and interests, including copyright, in such Property created of my minor child. The Grantees may use the Property for any non-profit or educational purposes, including, but not limited to: CTS Church Website, on private websites (ie, Shutterfly or Facebook), in special event photos (such as VBS), special event videos (promotion in worship, VBS, celebration of an event), CTS displays, in printed CTS material (Connections, flyers, brochures, slides), email newsletters and on the CTS and Children’s Ministry private Facebook page. I also hereby release Grantees from all claims, demands, and liabilities whatsoever in connection with the above. Please note: your child’s name will not be included with your child’s picture unless prior authorization is given.

Typing in my name below serves as my signature and that I have read and agree to the Media Release Agreement as stated above.

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Comments

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