• Adult Youth Leader Registration

    Adult Youth Leader Registration

    Diocese of Grand Island

  • Choose the event(s) you are applying for as an adult leader.

  • Higher Ground Retreats (High School Retreats)
  • Format: (000) 000-0000.
  • Birthdate*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender*
  • T-shirt Size*
  • Certified in CPR?*
  • CPR Certification Expires
     - -
    2 digit month, 2 digit day, 4 digit year
  • Certified in First Aid?*
  • First Aid Certification Expires
     - -
    2 digit month, 2 digit day, 4 digit year
  • Have you served as a youth leader in the past 5 years*

  • Emergency Medical / Liability Release

  • I hereby grant the Diocese of Grand Island, their staff, and volunteers permission to transport me in an emergency to a medical or healthcare facility for immediate treatment and/or consultation, if deemed necessary.  I give authorization to the attending physician, dentist, or medical personnel for any required immediate treatment at the time of the emergency.  I agree to be financially responsible for any and all medical expenses and/or treatment costs and all related services provided and I release the Diocese of Grand Island, their staff, and volunteers from any liability.

    I authorize the release of information to my insurance company and family physician.

    I understand that this event is sponsored by the Diocese of Grand Island.  I accept full responsibility for any legal or financial consequences which may result from any personal actions (ie. damage to property or other participants/staff/volunteers) taken by me and I agree to hold the Diocese of Grand Island, their staff, and volunteers harmless with respect to any actions or claims that may be made in connection with my personal actions. I also grant permission to the Diocese of Grand Island, their staff and volunteers to use photos and videos of me for publicity/marketing purposes.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Code of Conduct

    To help make all church events/activities a positive and meaningful experience for everyone, all participants must agree to the Code of Conduct. These guidelines are designed to promote respect, safety, and enjoyment throughout the event/activity. Staff/ volunteers have a responsibility to themselves and others to follow these guidelines:

    • Be Respectful and Safe. At a church sponsored event, we expect to create an environment of safety and trust. The use of our bodies, language, and humor must always honor the dignity of every person. If you jeopardize the physical or emotional safety of yourself or the group, you choose to have a parent or guardian pick you up and take you home immediately.
    • Be Responsible and Honest. Leaders are expected to be present at all activities on time and participate fully. Established guidelines will be observed at all times. We need to take care of the building and grounds. Any damage is to be reported immediately and involved persons are financially accountable. Emergencies that involve the health and well-being of people and/or property must be reported to the diocesan/event leader immediately.
    • The use of illegal drugs, alcohol, or other illegal/harmful substances is not permitted.  If you use these materials, you will be asked to leave the event immediately. Proper authorities will be notified as warranted. 
    • Observe appropriate boundaries. All participants must remain in designated areas at all times. One of the goals of a Catholic youth event is to foster community and engagement with all participants; therefore, exclusive relationships and activities that isolate individuals from the larger group are discouraged.

    Dress Code 

    In order to promote a safe, healthy and positive community experience the following dress code must be followed by all participants and adult leaders. Clothing should be modest and appropriate to a youth retreat/conference setting. Clothing should not present messages contrary to the values of a Catholic retreat.

    • All attire should be sized to fit without exposing undergarments, buttocks, stomachs or cleavage. 
    • Shorts and skirts must be at least fingertip length when arms are resting at sides.
    • Shirts must be long enough to naturally touch the top of the lower garment, with arms raised. Shirts must cover the shoulder. No spaghetti straps, tank tops, and halter tops or transparent/mesh clothing or shirts with revealing necklines or armholes.
    • No yoga pants or form fitting leggings.
    • No clothing or accessories that promote drugs, alcohol or tobacco either by brand or message.No clothing or accessories with sexually suggestive language, promote violence, criminal activity, or intimidation/intolerance of others in regards to religion, ethnicity, gender or lifestyle.
    • Modest swimwear appropriate for a Catholic retreat setting. No speedos or bikinis.

  • I understand and accept the guidelines and policies stated in this Code of Conduct. I will accept the consequences should I choose to violate the code. I agree to follow any disciplinary actions if I choose to behave in a manner that the diocesan/event leader judges to be a serious violation of this code and is contrary to the mission of a Catholic event/activity.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Trail Ride Release Fort Robinson State Park

    By signing my name at the bottom of the Release, I agree that, for and in consideration of the opportunity to ride a horse provided by this state park, I agree to pay for such ride and further agree as follows:

    • That I know and understand that this horse riding activity involves specific risks of property damage or personal injury to me or to my minor children arising from approaching, handling, mounting, riding, and dismounting the horse, irrespective of its training and usual past behavior and characteristics, may act or react unpredictably at times based on instinct or flight which likewise, is an inherent risk assumed by a horseback rider. 
    • That I hereby release and forever discharge the State of Nebraska, its agents, and employees from all present and future claims arising from personal injury or property damage sustained by me or my minor children during the use of the horse, and I shall assume all risk related to horseback riding. 
    • That I waive my right to file and promise not to file any legal proceedings against the State of Nebraska, its agents, or employees for any personal injury or property damage sustained by me or my minor children during this activity: and I shall pay all cost and attorney's fee from any legal proceeding which I may bring contrary to this agreement and which is resolved in favor of the State of Nebraska, its agents, or employees. 
    • That I sign the Release Agreement for and in consideration of the agreed price, and I hereby request the State of Nebraska, its agents, or employees to choose for me and for my minor children a horse for the purpose of riding same, knowing that the State of Nebraska, its agents, or employees are relying upon this Release Agreement and the information, that have given them concerning my experience and that of my minor children with horses, including the potential hazards involved. 
    • That I have read the foregoing release and sign it freely with knowledge of its meaning and content.

    Mountain Mania Rental Agreement (Tube & Kayak) Fort Robinson State Park

    THIS IS A LIABILITY RELEASE AGREEMENT

    Please read carefully before signing

    1. I accept for use as in the equipment listed on this form and accept full responsibility for the care of the equipment while it is in my possession. 
    2. I will be responsible for the replacement at full retail value of any equipment rented under this form, but not returned to Fort Robinson State Park rental office. 
    3. I agree to hold and indemnify Nebraska Game and Parks Commission, Fort Robinson State Park, Mountain Mania, agents, and employees, as well as the manufacturer and distributors of this equipment, for any loss or damage, including any that results from claims for personal injury, death or property damage related to the use of this equipment.
    4. I agree to return all rented equipment by the agreed date in clean condition to avoid additional charges. 
    5. I understand that there are inherent and other risks involved in the activity of tubing and kayaking for which this equipment is to be used, that injuries are a common and ordinary occurrence of this activity, and I freely and voluntarily assume those risks. 
    6. I hereby release from any legal liability Nebraska Game and Parks Commission, Fort Robinson State Park, Mountain Mania, agents, and employees, as well as the manufacturers and distributors from any and all liability, negligence, breach of warranty, contract, claim or product defect, or other legal theory, accepting myself, the full responsibility for any and all such damages or injury which may result.
    7. All instructions on the use of my rental equipment have been made clear to me, and I understand the functions of my equipment. 
    8. I will be responsible for all on my own actions. If I am not following the designated rules and regulations of the park, I may be subject to punishment and fines.
      This agreement is non-negotiable.
      I, {participantName}, have read and understand the rental and liability release agreement above.
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Maranatha Camp & Retreat Center Adult & Child(Minor) Participant/Volunteer Release:

    Waiver of Liability, and Indemnity Agreement 

    PLEASE READ CAREFULLY. THIS DOCUMENT affects YOUR LEGAL RIGHTS AND IS LEGALLY BINDING. BY SIGNING THIS AGREEMENT, YOU ARE RELEASING MARANATHA BIBLE CAMP & RETREAT CENTER FROM ALL LIABILITY AND FOREVER GIVING UP ANY CLAIMS, THEREFORE.

     Assumption of Risk
    I acknowledge and agree that any use of Maranatha Bible Camp and Retreat Center’s facilities, services, equipment, and premises (“Facilities”) and any participation in Maranatha Bible Camp & Retreat Center’s programs and activities (“Programs”) comes with inherent risks including, but in no way limited to (1) minor to severe personal/bodily injury, (2) property damage, (3) disability, (4) death, (5) sickness or disease, (6) emotional injury (7) financial damage. I voluntarily accept and assume full responsibility for these risks as well as all other risks of the use of Facilities and participation in Programs. I agree that I have full knowledge of the nature and extent of all such risks and am not relying on all such risks being described in this document.

     Waiver, Release, Indemnification & Covenant Not to Sue
    In consideration of the use of Facilities and participation in Programs I, the undersigned, agree that Maranatha Bible Camp & Retreat Center, it’s officers, directors, agents, employees, volunteers, insurers, and representatives (“Releasees”) will not be liable for any personal injury, property damage, disability, death, sickness or disease incurred by myself, my family members, dependents, or guests, including minors, however occurring including, but not limited to the negligence of Releasees. I understand that I will be solely responsible for any loss or damage, including personal injury, emotional injury, property damage, disability, death, sickness, or disease sustained from the use of Facilities and participation in Programs.

    I further agree, on behalf of myself and any and all legal successors and proxies, to release and HEREBY DO RELEASE, WAIVE AND COVENANT NOT TO SUE Releasees from any causes of action, claims, suits, liabilities or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I and any and all legal successors and proxies may have, now or in the future, against Releasees on account of personal injury, property damage, disability, death, sickness, diseases or accident of any kind, arising out of or in any way related to the use of Facilities or participation in Programs, whether that participation is supervised or unsupervised, however, the injury or damage occurs, including, but not limited to the negligence of Releasees.

    In further consideration of the use of Facilities and participation in Programs, I agree to INDEMNIFY AND HOLD HARMLESS Releasees from all causes of action, claims, demands, losses, suits, liabilities, or costs of any nature whatsoever, including claims of negligence, arising out of or in any way related to the use of Facilities and participation in Programs by myself, my family members, dependents, or guests, including any minors.

    Audio/Visual Waiver

    I understand that Maranatha Bible Camp reserves the right to use any audio, video, and/or photographs of any camper, guest, or staff member participating in any Maranatha facilitated event for promotional or marketing purposes. I have read and understood the media release as outlined above:

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Volunteer Driver Information - Complete this form if you are registering as a leader for Higher Ground week 1 or week 2*
    Rows

  • There may be a need for you to drive your private vehicle during the week of Higher Ground so we ask that you complete the above information as applicable. Please be aware that as a volunteer driver, your insurance is primary. The required minimum limits for liability insurance is $100,000/$300,000. Please provide a copy of proof of insurance for our files.

    In order to provide for the safty of those we serve, we must ask each volunteer to answer the following questions:

  • 1.   I have NOT had a conviction for an infraction involving drugs or alcohol (such as driving under the influence or driving while intoxicated) in the last three years.*
  • 2. I have had no more than three moving violations or accidents in the last two years.*

  • Certification

    I certify that the information given on this form is true and correct to the best of my knowledge. I understand driving for Church ministry is a profound responsibility, and I will exercise extreme care and due diligence while driving. I understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license, have the proper and current license and vehicle registration and have the required insurance coverage in effect on any vehicle. I agree that I will refrain from using a cell phone or any other handheld electronic device while driving my vehicle.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

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