First Calvary Baptist Church

Volunteers & Chaperones Sign-up Sheet for "2022 MLK Youth Lock-In"

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Volunteers & Chaperones Sign-up Sheet for "2022 MLK Jr. Youth Lock-In"

Date: Jan. 16-17, 2022

Location: Community Family Life & Recreation Center at Lyon Park, 1309 Halley Street Durham, NC 27707

Please contact: youthmlklockin@firstcalvary.org or Demisha Grimsley at 919-724-1307 for any questions.




Section I: Volunteer & Chaperone Information


First Name Last Name
Address
Address Line 2
City State Zip Code
Phone Number
Email Address
Click in box to select date
Select one
Small
Medium
Large
X-Large
2X-Large
3X-Large
Select one
Yes
No

Select one
Yes
No



Section II. Volunteer & Chaperone Medical/Special Needs/Accommodations





Section III: Volunteer & Chaperone Emergency Contact Information


First Name Last Name
Phone Number




Section IV: Availability:

Select one
Shift 1 (5:30pm - 9:30pm) - Max. 10 volunteers
Shift 2 (9:00pm - 1:00am) - Max. 9 volunteers
Shift 3 (12:30am - 4:30am) Max. 9 volunteers
Shift 4 (4:00am - 8:00am) - Max. 5 volunteers
Shift 5 (7:30am - 12:30pm) - Max. 9 volunteers




Section V: Orientation Sessions for Volunteers & Chaperones

All volunteers and chaperones are REQUIRED to attend (1) orientation session prior to MLK Jr. Youth Lock-In.

Select one
Thurs. January 06, 2022 (7:00pm - 7:45pm) via Zoom Meeting
Sun. January 09, 2022 (12:00pm - 12:45pm) via In-Person Meeting at FCBC - 1311 Morehead Ave. Durham, NC 27707
Mon. January 10, 2022 (7:00pm - 7:45am) via Zoom Meeting
Sat. January 15, 2022 (10:30am - 11:45am) via In-Person Meeting at FCBC - 1311 Morehead Ave. Durham, NC 27707



Section VI: Food Selection

Select one
Zaxby's Signature Chicken Sandwich Meal (includes chips, cookie, drink)
Zaxby's 3 Chicken Fingerz Meal (includes chips, cookie, drink)
Select one
Chicken biscuit
Sausage biscuit
Egg & Cheese biscuit
Plain biscuit



Select all that apply
I will monitor the behavior of youth by encouraging respectful behavior of themselves, adults and others.
I will remain with my assignment until my shift ends.
I will show leadership ability by displaying a positive attitude to all participants of the event.
I understand the lock-in event is FOR the youth, and I am present to ensure the safety of youth.
I understand that if I choose to come prior to my shift or remain after my shift that I may be asked to assist in the lock-in where needed.
I understand all volunteers MUST be at least 21 yrs. old or older to serve as a Volunteer.
I understand all volunteers are subject to a background check prior to the event.

Assumption of Risks and Waiver of Liability Relating to COVID-19:

COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, the West End Community Foundation and First Calvary Baptist Church have put in place certain protocols to reduce its spread. However, the West End Community Foundation and First Calvary Baptist Church cannot guarantee that you or your children will not become infected with COVID-19. The West End Community Foundation and First Calvary Baptist Church are following these enhanced procedures to prevent the spread of COVID-19:*Mask requirements *Social distancing protocols *Following the state mandated number of people for gatherings *Cleaning/Sanitizing of common, high-touch areas *Conducting wellness checks when needed Symptoms of COVID-19 include: *Fever *Fatigue *Dry Cough *Difficulty Breathing. On my behalf, and for and on behalf of my children and our heirs, assigns, and personal representative, I hereby release, Covenant not to sue, discharge, and hold harmless West End Community Foundation, First Calvary Baptist Church and its officers, agents, employees, sponsors and other participants, including all liabilities, claims, actions, damages, cost or expenses of any kind arising out of or relating thereto.
Select one
I acknowlege and agree to the terms of Assumption of Risks and Waiver of Liability Relating to COVID-19




First Name Last Name

* required