2023 Spring Semester T.A. Application
BSBC Korean School Volunteer Application
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1. Name (Last, First), Gender (M/F) *
2. Date of Birth *
3. Preferred Phone Number *
4. Home Address *
5. School Name / Grade *
6. Email Address *
7. Parent or Guardian Name / Phone *
8. Emergency Contact Name / Phone / Relationship *
9. Do you have any allergies or physical disabilities?
10. If yes, please explain.
11. Have you ever volunteered for a service organization? *
Required
12. If Yes, please explain
13.  Please let us know your strengths. *
Liablities:
1. Release of Liability:
By signing this Permission/Waiver Form, I expressly warrant that the child named above or I, if I am a participant, am capable of withstanding both the physical and mental demands of the activities discussed above. I also expressly assume all risks of the child or me participating in the activities, whether such risks are known or unknown to me at this time. I further release Berendo Street Baptist Church and its ministers, leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child’s or my family or estate, heirs, representatives, or assigns may have against Berendo Street Baptist Church or its ministers, leaders, employees, volunteers, or agents.
I further agree to indemnify and hold harmless Berendo Street Baptist Church and its ministers, leaders, employees, volunteers, or agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities.
2. Publicity:
On occasion, Berendo Street Baptist Church takes photographs or makes an audio videotape recording of children and/or adults involved in church activities. Such photographs or video records may be used in Berendo Street Baptist Church publications or advertising materials, (including the website and social media) to let others know about our ministry. In addition, local news organizations may hear of our activities or events, and our church may invite or allow them to photograph or record our events for news reporting on special interest features. I consent to the use of any such audio or visual record of the child named above or me, if I am participating, to be used, distributed, or displayed as agents of the church see fit. This consent includes but is not limited to: photographs, videotape, and audio recordings. Furthermore, I give permission for this child to be interviewed by the news media, or for such photographs and other audio or visual records to be used by the news media.
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14. Electronic Signature and Date *
Submit
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