Field House Renovation Project

Volunteer Role*

Area(s) of Renovation Expertise

Name*

First Middle Last

Date of Birth*

Gender*

Male
Femail

Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code

What church do you attend?

Church Phone Number

Church Address

Street Address City State / Province / Region ZIP / Postal Code

Questionnaire

1. Are you above 18 years of age or above?*

Yes
No

2. Are you a convicted felon and/or child molestor?*

Yes
No

3. Are you a Christian?*

Yes
No

4. Do you attend church on a weekly basis?*

Yes
No

5. On a scale of 1-10 how involved are you in ministry at your home church or in your city?*

(1 being not at all involved and 10 being extremely involved.)

6. Will you allow our ministry to perform a routine background check?

Yes
No

7. I am a…*

High school student
College student
Working adult

8. Name of School

8a. Employer

8b. Employer Address

Street Address City State / Province / Region ZIP / Postal Code

8c. Employer Phone

9. Why do you want to work with The Megan Kelley Dream Center as a volunteer?

10. Briefly, explain the moment that you were saved:

References

Non-family Reference

First Last

Phone

Relationship

Pastoral Reference

First Last

Phone

Relationship

In Case of Emergency

Emergency Contact

First Last

Phone

Relationship

List of Medical Conditions, Allergies, and Any Prescribed Medicines, etc.

Past-experience with ministry/volunteering (if applies):

Right of Representation and Release of Liability

In consideration of my participation with Breakaway Ministries and The Megan Kelley Dream Center for the year of 2018, agree that:

I grant to any of the Breakaway Ministries, Inc. and The Megan Kelley Dream Center, its leaders, or their contracted agents and its leaders the right to represent me in decisions relating to my welfare or the group welfare during the particular event, and I agree to follow those suggestions made on my behalf.
I hereby grant any of the Breakaway Ministry, Inc. and The Megan Kelley Dream Center leaders or contracted agents my permission to authorize medical treatment and medications on my behalf. I also understand I will not hold Breakaway Ministries, Inc. and The Megan Kelley Dream Center, or any of its leaders, or any contracted agents responsible for the results of such treatment, medications, or decisions made on my behalf.
I understand that risks including, but not limited to, death or injury by accident, disease, terrorist acts, weather conditions, and inadequate medical services and supplies. I accept these conditions with full awareness and I assume all risks of death, injury, illness, terrorist assaults, and personal property loss or damage associated with such risks.
I waive any and all claims for damages against Breakaway Ministries, Inc., The Megan Kelley Dream Center, their leaders, and their contracted agents, arising from death, injury, illness, inconvenience, or in property damage or loss occurring for any reason included but not limited to any negligent act or acts of Breakaway Ministries, Inc. and The Megan Kelley Dream Center, its leaders, or contracted agents which may in any way cause death, injury, illness, inconvenience or property damage or loss to me. I have read this release in its entirety, understand its contents, and agree to all of them of my own free will.
Governing Law/Venue: In accepting service from us in this agreement shall be governed only by the laws of the state of Alabama. I hereby relinquish all rights to pursue any legal action against Breakaway Ministries, Inc. and The Megan Kelley Dream Center, its leaders, its staff, its volunteers, and the contracted agents of Breakaway Ministries, Inc. or the venue for the pursuit of any legal action against the above stated parties.

I hereby certify that all the information provided above is true and without omission. I also understand that I am not guaranteed acceptance into the volunteer position with Breakaway Ministries, Inc. and The Megan Kelley Dream Center. I understand fully that the action of providing falsified information is against the moral and biblical code of Breakaway Ministries, Inc. and that I will not be accepted if I have omitted or falsified information. I also accept that it is not my right to serve but my privilege to be able to serve God through this ministry.

Electronic Signature*

Field House Renovation Project

Volunteer (1)

Questionnaire

References

In Case of Emergency

Right of Representation and Release of Liability