EmailMeForm
Niko Camp
General Contact Information
Full Name:
*
First
Last
Gender
*
Male
Female
Age:
Date of Birth:
MM
/
DD
/
YYYY
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Email
*
Daytime phone
In case of emergency, please call:
*
First
Last
Emergency contact# :
Spiritual Background
Please tell us a little about your salvation testimony below:
Describe your current relationship with God:
If you could change something about your relationship with God what would it be?
Have you ever participated in King's Kids, Access, or Outreach before?
yes
no
If yes, what team and dates?
If no, move on to the next question.
Why would you like to participate in this Niko camp?
About Life and Vision
What do you see yourself doing in five years?
If you are not sure what they are, say so, but indicate the things that interest/excite you
Describe your skills/talents/gifting- (creative and spiritual)
If you are not sure what they are, say so, but indicate the things that interest/excite you
About Leadership
Would you consider yourself a leader?
yes, absolutely
no, never
somewhat, in some circumstances
Other
Briefly explain your answer below:
Please list 3 of your strengths, and 3 of your weaknesses:
How would you define the concept of "team":
Liabilities and Permissions
Please carefully read before agreeing or declining, as these terms will be considered binding. This is our acknowledgement of risks and liability agreement.
As an applicant for NIKO, I take the responsibility, if accepted as a participant for this camp, to obey all the rules and regulations governing my behavior during this experience and to give my full attention and support to the staff in order to make this event a success for all the participants.
I agree completely
I refuse
Other
I/We recognize the element of risk in any adventure, sport, or activity associated with the outdoors. I/We are fully aware of the risks and dangers inherent in activities such as but not inclusive to:
- Hiking on and off trails ranging from gentle to steep and difficult
-Trust exercises and other active games
I agree completely
I refuse
Other
I acknowledge the inherent risks in the above activities (in order), and will take full responsibility for exposing myself to:
1. Sunburn, dehydration, blisters, falling, twisted ankles, etc.
2. Bites, stings, allergies, reactions, etc.
3. Falling, twisted ankles, etc.
I agree completely
I refuse
Other
I/we certify that I/we have the necessary skills and abilities to participate in the said activities and assume full responsibility for myself (and others) for bodily injury, death, and loss of personal property and expenses thereof as a result of my/our) negligence in participating in said activities except to the extent such damage or injury may be due to the negligence of YWAM/ King’s Kids/ NIKO staff.
I agree completely
I refuse
Other
I/we also agree to abide by the rules or instructions given to me verbally or written. Youth With A Mission reserves the right to refuse to allow any person to participate who is judged to be incapable of meeting the rigors and requirements of participation. I/we have read, understood , and accepted the terms and conditions to the entire course.
I agree completely
I refuse
Other
If I become ill or experience an accident during this camp, I/We hereby agree to the performance of such treatment, anesthetics and operations as is deemed necessary in the opinion of the attending physician.
I agree completely
I refuse
Other
I/we hereby grant permission for the performance of any emergency treatment that may be required in the case of an accident or illness wherein I am rendered unconscious or unable to approve of the required medical treatment. Or as a parent/guardian, I give permission for said treatment to be given to my minor child.
I agree completely
I refuse
Other
Form filled out by
First
Last
Name of the adult participant, or the parents of the minor child
Signature
Clear
Date of Application
MM
/
DD
/
YYYY
