Youth Application Form

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Youth Information

This application is designed to be filled out by the youth and guardian together. It must be signed by a legal guardian.
Static SF Fields - Update Yearly!

Youth Information




Leave blank if you don't have the youth's email! Do not enter a parent/guardian email.

Enter the youth's cell number. If they don't have a cell phone, enter their home phone.















Application Information

Application Information
We do our best to accommodate your branch preference. However, we cannot guarantee openings in all branches.
Yes No

* This information is kept anonymous and only used as part of our efforts to raise more funds for our youth programming at MCC.



Legal Guardian/Emergency Contact

List at least two separate contacts with two different phone numbers. MCC will make every effort to call contacts in the order listed. Emails may be used to provide information about MCC programs. 
Legal Guardian 1 Information



Do not enter the same email as the youth




Yes No





Legal Guardian 2 Information



Do not enter the same email as the youth




Yes No





Emergency Contact Information (Must be Different From Above)
Please provide an alternative Emergency Contact, in addition to the Parent/Guardian






Yes No






Health History Introduction

Montana Conservation Corps wants your child to have a successful and positive experience this summer. Thank you in advance for sharing the most up to date medical information and verifying your child can perform the tasks required for participation listed below. 

Each year youth participants with a variety of medical and mental health backgrounds have successfully participated in MCC programs.  If your child has a disability, we strongly encourage you to contact MCC staff so that we can discuss reasonable accommodations prior to the start of the program. 


Any enrollment acceptance is conditional upon completion of the health history questions on the following pages. Youth participating in MCC programs must be able to:  


·        Walk on uneven, outdoor terrain and negotiate natural obstacles, such as hills, streams, and boulders. 

·         Live in a rustic location not always accessible by vehicles. 

·         Sleep in their own tent, near other teens and adult leaders within an established campground area.

·         Participants must remain in their tents at night, except to go to the bathroom, and must wake their expedition leader in case of emergency.

·         Lift and carry a backpack for hiking and working. 

·         Eat provided meals and drink water regularly. 

·         Refrain from using a cell phone or other internet connected devices, except in MCC approved situations. 

·         Follow directions and participate willingly in work activities, camp chores, and community living activities. 

·         Refrain from violence, hitting, verbal assault, bullying, any inappropriate or unwelcome touching, or any similar behavior. 

·         Show respect for others, work/live/play/interact in large and small groups without constant one-on-one assistance.

·         Continue taking prescribed medication. 

·         Participate in normal activities related to self-care, health, and hygiene.

·         Abide by MCC policies as explained by staff and leaders. 

·         Promptly notify MCC staff and/or leaders of any health condition that requires medical attention or change of activity. 

·         Able to sleep through the night without wetting the bed 

Health History

The information on this form is to be completed by a legal guardian and is required for your child’s enrollment in any MCC program. A 'yes' to any condition does not necessarily disqualify your child.

Please check “Yes” or “No” on if your child has been diagnosed or treated for the following. Explain all “Yes” answers on the space provided below. 
Yes No

Yes No

Yes No




Please check “Yes” or “No” on if your child is current on the following vaccinations
Yes No
Edit this text

Medication Information

Medications must be brought in the original bottle or container with prescription information on the bottle. The parent/legal guardian shall provide written instructions, as prescribed by the physician, and shall give written consent for the Crew Leader or MCC Staff to directly monitor the self-dispensation and self-administration of medications to MCC participants under 18 years of age. 
Yes No

MCC crews carry a small amount of over-the-counter medications such as Benadryl, Ibuprofen, Aspirin, cold medicine, allergy medicine, sunscreen, bug spray or antidiarrheal in their first Aid Kits.   These are not intended for regular use, but available in case a need arises. 
Yes No

Diet and Nutrition

We provide healthy, high quality food and regularly accommodate omnivores, vegetarians, vegans and gluten- free diets.  However, in the case of multiple allergies, we may not be able to provide for all special food needs. We do our best to accommodate a wide range of eating habits, but cannot guarantee that all needs can be accommodated. 
Yes No

Health Insurance Information

Enter “NA” for all blanks if uninsured, or “IHS” if Indian Health Service is main provider 






Legal Guardian Waivers, Release & Agreements

This Youth Program Guardian Agreement, Release, and Acknowledgement of Risk are executed by the parent or legal guardian. The parent or legal guardian do hereby freely, voluntarily, and without duress, make the following representations and execute this release under the following terms. 

I have read the description of MCC’s Medical screening process and MCC’s program, and I understand that the program is a physically and mentally strenuous activity. The information I have provided is complete and accurate.  I realize that failure to disclose such information could result in serious harm to my child and/or fellow members of their crew, and I agree to indemnify and hold MCC harmless if all relevant information is not disclosed.  I also agree to notify MCC should there be any change in my youth’s health status prior to their start date or during their term of service. 

In the event that my child is in need of emergency medical treatment during their time with MCC, and neither I nor the emergency contact I provided, can be contacted, I hereby authorize MCC and its instructors, volunteers or staff to obtain or provide emergency hospitalization, surgical or other medical care for the member. I, the parent/guardian, specifically indemnify and hold harmless MCC, its instructors, volunteers or staff from any negligence and all costs arising out of the decision to obtain and provide such care, treatment and/or procedure for such emergency.

I certify that my child can be depended upon to independently accept responsibility for taking their medication according to doctor’s instructions. The Crew Leader or staff at MCC has my permission to directly monitor the self-dispensation and selfadministration of the medications listed within this document to my child.  I understand that opportunities to refill prescriptions during an MCC program are limited and that my child is expected to arrive with enough medication to last the entire session.  I also understand that in the instance that the medication it is damaged or lost I may be asked to bring replacements to the MCC or directly to my child.   

I understand that this information must be provided before anyone taking prescription drugs can be allowed to join an MCC program, and that it will be used to help determine whether MCC can safely enroll my child. I understand that MCC has the right to immediately suspend or dismiss my child if they fail to take the prescribed dosage, or if not enough medication is provided for their time with MCC.  If my child is dismissed, I understand that I will be responsible for the cost of their transportation home. 

There will be times when it is important for those who respond to an incident in the field to know relevant medical history in order to provide the best planning, response or medical care.   

I give my permission to allow MCC staff to disclose only the personal health information that is relevant to my child’s time with MCC. I authorize their health care information to be released only to MCC staff, participants and medical responders for the purposes of injury prevention, prevention of the aggravation of existing conditions, and for medical care. I understand that this authorization will remain in effect from the date of this authorization until the completion of their service with MCC.

This Youth Program Guardian Agreement, Release, and Acknowledgement of Risk are executed by the parent or legal guardian. The parent or legal guardian do hereby freely, voluntarily, and without duress, make the following representations and execute this release under the following terms. 

 

1. Purpose This agreement delineates the terms, conditions, and rules of conduct regarding the participation of the Youth listed above (hereinafter referred to as ‘Youth’) in the Montana Conservation Corps Youth Service Expedition Program (hereinafter referred to as ‘MCC’).  

 

2. Service Award High School Expedition Participants will receive a service award upon successful completion of the entire term of service. 4 Week Expedition and 2 Week Expedition Participants will receive different service award amounts based on their length of service. 

 

3. Code of Conduct While serving with MCC, the Youth is expected to: 

·       Show respect when interacting with other members, leaders, staff, project sponsors and community members. 

·       Participate fully in all aspects of the program at the level of their ability. 

·       Exhibit a high level of commitment and a positive attitude toward the organization, staff, and service work. 

·       Display a strong work ethic and follow directions. 

·       Direct concerns, problems, and suggestions to the appropriate MCC staff. 

·       Be on Time. 

·       Use appropriate language at all times. Wear appropriate footwear, clothing, and safety gear. 

·       Avoid any activity that may physically or emotionally damage participants of MCC or others. 

Cell phones, portable stereos/radios, MP3 players, DVD players and other similar devices will not be allowed while participating with MCC’s Youth programs. Crew leaders will be permitted to carry cell phones for emergency purposes or to communicate with MCC staff.  Member’s cell phones or other electronic devices will be collected and returned only when the work day/week is over. 

 

Violations of any of the below policies may be grounds for immediate suspension by staff with termination pending approval by Senior Program Staff.  At no time may the Youth: 

·       Engage in any activity that is illegal under local, state or federal law. 

·       Engage in activities that pose a significant safety risk to others. 

·       Consume, possess, or be under the influence of alcoholic beverages or tobacco products. 

·       Consume, possess, or be under the influence of illegal drugs. This includes misuse or sharing of prescription drugs. 

·       Engage in harassing or aggressive behavior. This includes verbal, sexual, racial and physical harassment. 

·       Engage in fighting or threats of violence. 

·       Possess or use firearms or weapons. 

·       Participate in vandalism or theft. 


4. Acknowledgement and Assumption of Risk   The Parent or guardian understands that the activities engaged in while volunteering with MCC may include activities that may be hazardous to the Youth, including, but not limited to trail building, construction, habitat enhancement, cleaning, loading, unloading, and transportation to and from work sites. As the person legally responsible for the Youth participant, I recognize that such volunteer activities involve certain risks and dangers, and that accidents are possible.  In light of this knowledge, I undertake full responsibility for all harm that comes to any person for whom I am legally responsible as a result of being a Youth participant in MCC’s activities.  Some (but not all) of the possible risks faced by participants include the following:  intentional or careless acts of other parties; dangerous weather conditions; the use of vehicles; dangers associated with first-aid, emergency treatment, or other services rendered; and consumption of food or drink.  With full knowledge of the risks inherent in such activities, I release and agree to hold MCC harmless from any and all liability for any accident or injuries from which any person for whom I am legally responsible, might suffer damages, to the fullest extent allowed by law. 

 

5. I understand and acknowledge that the above list is not complete or exhaustive, and that other risks, known or unknown, identified or unidentified, may also result in injury, death, illness, disease, or damage to any person for whom I am legally responsible, or to my property. 

 

6. I understand and acknowledge that when a minor participant attends an MCC activity or event with a parent or legal guardian, the minor participant shall be under the care, control, and supervision of the accompanying adult. 

 

 

7. I agree to defend and hold MCC harmless against any claims, demands, liabilities, actions, suits, and proceedings of every kind, including the costs and expenses thereof, brought or filed against MCC arising out of my intentionally tortuous actions.  In case such a claim should be brought or an action filed against MCC, I agree that MCC may employ an attorney of their own selection to appear and defend the action on behalf of MCC, and that I will bear the expense of such defense. 

 

8. It is understood and agreed that MCC assumes no responsibility for the theft, loss, damage or disappearance of participants’ personal property.  I agree that my personal property, or the personal property of the minor for whom I am guardian, is my sole responsibility, and I bear all risk of loss or damage. 

 

9. Waiver and Release The activities the Youth engages in with MCC are inherently risky and may cause harm to the Youth including injury, illness or even death. Recognizing this, Youth and guardian do hereby release, to the fullest extent allowed by law, and forever discharge and hold harmless MCC, its staff and board, its successors, and assigns from any and all liability, claims and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the Youth’s work with MCC.  Youth and guardian understand that this release discharges MCC from any liability or claim that the Youth and guardian may have against MCC with respect to any bodily injury, personal injury, illness, death or property damage that may result from the Youth’s work for MCC.  Youth and guardian also understand that MCC does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury or illness.     


10. Video and Photo Release.  The volunteer and guardian do hereby give full consent to the Montana Conservation Corps to copyright or publish all videos and photographs in which the volunteer may appear.  The volunteer and guardian do hereby understand that MCC is a highly visible program within the community and media eye, and hereby give consent for release of all video and photographic materials and waive any right to inspect or approve of the finished product.

 

11. Insurance The parent or guardian understands and acknowledges that MCC does not carry or maintain health, medical, or disability insurance coverage for the Youth. 

 

12. It is agreed and understood by and between the parties that any legal dispute arising out of the Agreement is to be adjudicated under the laws of the State of Montana. 

 

13. It is also agreed and understood by and between the parties that if any Court should vacate or strike any portion of this Agreement, such vacating or striking will be limited solely to the provision that is held invalid and will not affect any other portion of this Agreement. 


14. I understand that this is the entire agreement between me and MCC, and it cannot be modified or changed in any way by the oral representations or statements of any employee or agent of MCC, or by me. 

 

I HEREBY ACKNOWLEDGE RECEIPT OF A COPY OF THIS AGREEMENT.  I ALSO ACKNOWLEDGE THAT THIS RELEASE WILL CONTINUE IN EFFECT ANY TIME MY CHILD PARTICIPATES IN AN MCC LED OR SPONSORED ACTIVITY.  IF I DO NOT FULLY UNDERSTAND THIS AGREEMENT AND RELEASE AND THE EFFECT OF ITS PROVISIONS, I WILL SEEK APPROPRIATE ADVICE OR CLARIFICATION BEFORE I SIGN IT.




I certify that the statements on this form are true, complete and correct to the best of my knowledge and belief, and are made in good faith. I understand that any false statements made herein could void my youth participant eligibility to serve with MCC, or could result in disciplinary action up to, and including termination.

  


(checking the checkbox above is equivalent to a handwritten signature)
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