Application Form Leader Application Form Name* First Last Gender Male Female Cell Phone NumberEmail Address* Enter Email Confirm Email Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Birth date MM slash DD slash YYYY College College Graduation Year Are you currently playing college lacrosse?* Yes No PositionSelect oneAttackMidfieldDefenseGoalieFOGODesired Age Group to Work WithSelect one8-1112-1415-18Shirt SizeSelect oneSMLXLXXLShorts SizeSelect oneSMLXLXXLSocial Media Handle/Username General ExperienceWhat leadership experiences have you had?* What experiences do you have in teaching the bible?* What experiences do you have in counseling youth?* What would you say are your strengths?* Covid-19 ProtocolWAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19 ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate on behalf of FCA Lacrosse Camp and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (insert name of sports organization) their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.* I agree to the Covid-19 Policy Name* First Last Date* MM slash DD slash YYYY FCA Lacrosse does not require Huddle Leaders to be vaccinated, however to date have you been vaccinated? Yes No Date(s) Vaccinated MM slash DD slash YYYY Spiritual LifeHow do you see your relationship with God?*FatherFriend/TeammateStrangerOtherIf you chose (other), please specify If someone followed you around for a day, how would they see Christ in your life?* Have you ever been involved with the FCA ministry, or any other sports or campus ministries, if so, what was your involvement?* Why do you want to be a FCA Lacrosse Camp Huddle Leader?* "FOOD FOR THOUGHT" How would you describe your relationship with Jesus Christ using a fruit or vegetable? And why? Reference RecommendationPlease Provide a Reference* First Last Relationship Email* Who is someone you would want to refer to FCA Lacrosse First Last Grade or Year in College School Phone NumberEmail CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
