Sports Camps Registration – Coaches By | February 24, 2017 Email Address* Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Cell Phone*Emergency Contact* First Last Emergency Contact Phone Number*Name of SchoolShirt SizeXSSMLXLAdult sizes onlyAllergies* Current Medications Briefly describe pre-existing injuries or other special medical conditions, or activities to be restricted*Select the Adult Camp Opportunity you Desire*I am an adult/college (18 years old) student assisting at camp during the day (by invite only) or providing dorm supervision at night (Pay: Room/Board)I am an adult/college student (18 years old) desiring to stay in the dorms, but do not want to assist with camp in any way (Cost: $50 for Room/Board)Select the Camp Track you will attend*Girls BasketballBoys BasketballGirls SoccerBoys SoccerGirls VolleyballBoys VolleyballOrientation/Prerequisites* I will attend camp staff orientation I have watched the children's worker video (link below) I have reviewed and understand the Maranatha child worker rules (form linked below) As an active member of the camp staff, I agree to conduct myself in accordance with the MBU Student Life Handbook (linked below), and I take full responsibility for breaches of the handbook. I agree to abide by the child worker rules and leadership instructions in my service with children on the behalf of Maranatha CHILDREN'S WORKER VIDEO MARANATHA CHILD WORKER RULES Student Life Handbook Background Check Release Form*I agree to a background check. PLEASE NOTE: You will receive an email to the address listed above prior to the start of the camp from Brenda Kurtz and Maranatha. This email will contain a link to a secure online form provided by ScreeningONE. The link will remin active for 14 days. We request that you complete the form at your earliest convenience.Maranatha Baptist University 745 West Main Street, Watertown, WI 53094 The information contained in this Notification and Release is for use in my role working and/or volunteering with minors at Maranatha Baptist University (hereinafter, "Maranatha") and is true to the best of my knowledge and belief. I understand that any misrepresentation or false statement made by me in connection with this Notification and Release or any related documents which is deemed material by Maranatha shall result in Maranatha declining use of my services or requesting my dismissal from Maranatha-sponsored camps and events. I understand and agree that all information furnished may be verified my Maranatha or its authorized representative. I hereby acknowledge that I have been informed by Maranatha that Maranatha may seek to obtain an investigative report that will include personal information regarding me, including but not limited to, educational history, work references, driving record, drug testing and criminal convictions or arrest records if allowed, in order to assist Maranatha in making certain decisions. I further acknowledge notification by Maranatha that reports may be provided to Maranatha by other firms subcontracted for that purpose. I, my heirs, assigns and legal representatives, hereby release and fully discharge Maranatha, its parent and affiliated companies and the respective officers, directors, shareholders, employees, agents of each, including subcontractors, from any and all claims, monetary or otherwise, that I may have against Maranatha, its parent, affiliates or subcontractors, arising out of the making, or use of, an investigative report, including any errors or omissions contained or omitted from such reports or investigations. Maranatha agrees to inform you if the decline of your services has been influenced by information contained in such reports. SIGNATUREBy signing this form, I agree to fulfill the camp staff requirements if I qualify and am selected for this positionONLINE SIGNATUREToday's Date* This iframe contains the logic required to handle Ajax powered Gravity Forms.
