Loving Hands Ranch Volunteer Application

Please fill out this form in it's entirety. You will be contacted by the leadership team with camp dates and responsibilities once approved. LHR's volunteers are at the heart of this Deaf ministry. We ask that you have a spirit of service and a willing heart to help with various camp needs.

Legal Name:

First Name

Last Name

Phone Number:

Date of Birth

Month

Day

Year

Date

Gender:

Male

Female

Your email:

example@example.com

Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Please select a t-shirt size

Please select which option best describes you:

I am Deaf

I am Hard of Hearing

I am Hearing

Other

American Sign Language Skills:

Fluent

Proficient/conversational

Learning

I don't know ASL yet

Which camp(s) will you be volunteering for? Select all that apply:

Deaf Teens, June 12-15, going into 7th grade through HS graduation

Deaf Kids, June 19-22, ages 6 through going into 6th grade

Deaf Unique Needs, June 19-22, ages 6 and up

CODA (Child of Deaf Adult), June 26-29, ages 6 through HS graduation

I'm interested in volunteering for all camps

I'm available for any of the camps, tell me where I can best serve!

Do you have any known allergies, medication, or medical conditions? Please describe below. If you take medication please list time and dosage.

Briefly describe your relationship with Jesus Christ

Have you volunteered with LHR or other Deaf ministries before? If no, please list other volunteer experiences. Briefly describe below:

Any questions, concerns, comments, or information you'd like to provide?

Have you ever been accused, charged with, or alleged to have committed any act of neglect, abuse, or molestation against a minor?

Yes

Local personal references (must be at least 18 years old and not related to you)

This should be people who can speak to your character, work ethic, and overall ability to be a Christ loving volunteer for LHR.

Reference Name

First and Last Name

Reference Phone Number

Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Relationship to Reference Person #1:

Emergency Contact Information

This person will be contacted if parent/guardian cannot be reached in the event of an emergency.

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

Emergency Contact Email

Relationship to Emergency Contact

Consent for photo release:

I hereby grant permission to Loving Hands Ranch to use photographs and/or video of my camper/campers taken during camp(s) in publications, news releases, online, and in other communications related to the mission of Loving Hands Ranch.

I agree to photo release

I do not agree to photo release

Informed Consent and Acknowledgement

I hereby give my approval, as parent/guardian to camper(s) listed above, for participation in any and all activities prepared by Loving Hands Ranch (LHR) during the selected camp. In exchange for the acceptance of camper candidacy at Loving Hands Ranch (LHR), I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless LHR, and all its respective officers, agents, and representatives from any and all liability for injuries arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said camper(s), I hereby waive all claims against LHR including all staff, volunteers, entities, all participants, owners and lessors of camp premises used to conduct the events. There is a risk of being injured that is inherent in various activities.

Loving Hands Ranch is not responsible for lost, damaged, or stolen items/belongings including, but not limited to, hearing devices/amplification, medical devices, personal items, and other.

Initial here to acknowledge you've read the above statement:

Medical Release and Authorization

As the parent/legal guardian of named camper(s), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the named camper(s), in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the camper's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper(s). In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact the listed emergency contact person in the most expeditious way possible.

Permission is also granted to Loving Hands Ranch and its affiliates including Directors, volunteers, and other known affiliates to provide the needed emergency treatment prior to admission to the medical facility.

Release authorized on the dates and/or duration of the registered camp sessions.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named camper(s).

Initial here to acknowledge you've read the above statement:

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Signature field is empty.

Type Signature Name Below

First Name

Last Name