PLEASE READ CAREFULLY, AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION. I will be present at Crew Member Orientation the day before BREAKAWAY and will notify Lift Disability Network as soon as possible in the event I am not able to attend the week I have applied for. I have given my Social Security # for the release of my criminal records to determine acceptance and have given consent on the Authorization Form. I will show respect for all staff members and families, and I understand that the BREAKAWAY Director has the right to dismiss any Crew Member in the best interest of BREAKAWAY. Permission is given only to Lift Disability Network to use photographs (individual or group) and/or multi-media images and recordings in the best interest of Lift Disability Network. I understand that photographs/video/images I take at any BREAKAWAY/Lift Disability Network function are for my personal use only. Personal internet use of any video/media should be approached with caution with regard to misrepresentation.  I realize I am responsible for my own actions during the designated time period of BREAKAWAY, and that my legal protection under the Volunteer Protection Act covers my actions only when I am following the written policies and procedures of Lift Disability Network.  I will be a constructive member of the Staff, being a Christ-like example in all my actions, contributing in every way to the unity and purpose of the BREAKAWAY.  I will always have another adult present when I am with children and youth and will never be alone with a child under the age of 18.  I will pray daily for BREAKAWAY and each person in my care.  I realize that tobacco, alcohol, and illegal drugs are NOT ALLOWED.  I understand that all staff, including myself and all participants, have limited insurance coverage against injury or illness only. Therefore, if my misconduct results in a lawsuit, I understand I will represent myself. I shall indemnify Lift Disability Network and its staff, and hold them harmless from and against liability or responsibility for my negligence or misconduct.  I understand that 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,  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,  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.  I authorize Lift Disability Network to contact all prior employers and any references listed herein to verify all information provided and to obtain any and all information related to my character and past work performance. I release all references and prior employers from any liability for information provided in good faith.  The information contained in this application is correct, to the best of my knowledge. I have read the above statements and agree to cooperate with Lift Disability Network and the BREAKAWAY Staff.