YES Staff Registration Form

YES Staff Registration Form

The Kairos YES Retreat
Part 1 of 4: YES Retreat Information
Name of Event

2024 YES Retreat

Sponsoring Organization

Kairos North America (a DBA of the Sword of the Spirit)

Date

Friday, April 5 - Sunday, April 7, 2024

Cost

Staff - $165 (youth are $215)
Discounted staff- $145

Registration will close after March 22

Cost will increase $50 on March 15

Location

Michindoh Conference Center, 4545 E. Bacon Rd. Hillsdale, MI 49242

Michindoh’s Phone Number

517-523-3616

Arrival/Departure Info

Registration opens at 5:00 pm on Friday
Dinner is available from 5:30-7:00pm. The first session begins at 7:30pm.
The retreat ends at 1:00 pm on Sunday

Supervising Adults

James Munk, Stephen Giles, Molly Kilpatrick

Emergency phone number

Administrator: 517-402-3631 or Supervisor: 517-402-8271

What to bring
- Bible
- Notebook and pen
- Bedding (pillow, sleeping bag or sheets)
- A towel and toiletries
- Warm clothing
- Recreation clothing
- Something nicer to wear for the Lord's Day
Transportation

Please arrange your own or contact your Youth Group Leader
Part 2 of 4: Staff Information
Name*

First NameLast Name
Email*

Confirmation EmailConfirm Email address
Phone Number*
Please enter a valid phone number.
Sex*

FemaleMale
Birth Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Community Location*

Ann Arbor - Word of LifeColumbus - CornerstoneDallas - Families For ChristGrand Rapids - Light of ChristKansas City - Heart of the RedeemerLansing - Work of ChristLivonia - Christ's Ardent Disciples in ActionLos Angeles - City on the HillMaryland - Triumph of the CrossMiami - Comunidad La Nueva JelusalénMinnesota - Community of Christ the RedeemerNew Jersey - Family of FaithNew Jersey - People of HopePhoenix - City of the LordPittsburgh - People of GodSeattle - Beacon of JoyTallahassee - Fountain of LifeToronto - Jesus the Good ShepherdToronto - One With God CommunityVancouver - Families for Christ CommunityOther
City and/or community that you're coming from*
Name of person inviting you (if coming as guest)*
Tradition or Church Background*

AnglicanBaptistCatholicLutheranNon-DenominationalOrthodoxPresbyterianReformedOther
How are you connected to your youth group?*

I am a staff/volunteer/parent coming with the youth groupI am a college student and not connected to a specific youth groupI am not directly working with youth (Emcee, Nurse, Kairos Executive Team, Speaker, etc.)
What is your primary role at YES Retreat?*

Youth Group Leader/SupervisorSmall Group LeaderChaperone/DriverSecurityWorship TeamSupport Staff (Emcee, Nurse, Sound, etc.)Speaker/Breakout LeaderOther
Years on staff at YES Retreat:*

This will be my 1st or 2nd year as staff at YES RetreatThis will be my 3rd or more year as staff at YES Retreat
First and second year staff will participate in a Staff Onboarding Zoom Call. Please select which session you will attend (please mark this in your calendar, as attendance is very important). You will receive a Zoom link via email.
Staff Onboarding Zoom Call*

Sat, March 23, 11AM –12:30PM ESTTues, April 2, 7:30 – 9:15PM EST
T-Shirt Size - cost for a t-shirt is included in the retreat fee*

SmallMediumLargeExtra-Large
Emergency Contact's Name*

Emergency First NameEmergency Last Name
Emergency Contact’s Relationship to you*
Emergency Contact's Phone*
Please enter a valid phone number.
Part 3 of 4: Medical Information
Health Insurance Provider*
Health Insurance Card Holder's Name*
Health Insurance Policy Number*
Doctor's Name*
Doctor's Phone Number*
Do you have any dietary allergies or concerns?*

NoYes
Dietary allergies or concerns explanation*
Please explain the dietary allergies or concerns. Kindly also inform us of their severity i.e. type of reaction (rash, hives, difficulty breathing, vomiting). There is a refrigerator available for those needing to bring special foods; the kitchen can also make some accommodations if notified in advance. Do let us know if you plan to bring food, or if you would like us to speak with the kitchen and determine if we can accommodate your needs.
Are you currently taking any medications?*

NoYes
Current Medications List:*
Please list and explain the medications, including the medication name, amount, and regimen.
Are you allergic to any type of medications?*

NoYes
Medication allergies explanations:*
Please list the medication(s) to avoid. This information will be useful to provide if you require medical attention.
Medical Conditions: Have you experienced any of the following:

Asthma/Wheezing/Hay FeverStomach/bowel problemsDiabetes/HypoglycemiaConvulsions/Seizures/EpilepsyFainting spellsThyroid problemsHeart problemsMobility Concerns
Medical Conditions explanation:*
If any above medical conditions are checked, please explain. For example: If you have asthma, is it exercise induced? What triggers an attack? Is it controlled with medication? What medication, dose and frequencies? Have you ever been hospitalized for an asthma attack? If yes, how frequently and when was the last admission?
Other Medical: Are you being treated for any other injury or sickness that you haven’t already indicated above?*

NoYes
Other Medical explanation:*
Please describe any other medical condition that would be helpful for our staff or medical personnel to know. If there is a need to take you to the hospital the information on this form will be used to assist in giving the best possible care.
Part 4 of 4: Consent and Payment
Consent to Participate*
VERY IMPORTANT: to serve at the YES Retreat, you must read and agree to abide by the following Kairos Staff and Volunteer Conduct Code. You are responsible for reading this section.

May 20, 2020 (revised March 2008, March 2011, July 2012)

The following is the policy of Kairos applicable to both volunteer and paid youth workers for all events run, sponsored by or co-sponsored by Kairos that involve minors (persons under the age of 18).

Eligibility for Service
As a Christian organization, Kairos expects its youth workers to be active Christians who support and live consistently Christian morality and the teachings of The Sword of the Spirit. Kairos youth workers must have been participating for at least 6 months in the formative pastoral care of the communities and outreaches affiliated with The Sword of the Spirit, or shall clear our Staff Exception Policy.

Standards of Conduct
1. Youth workers will conduct their ministry efforts in such a manner as to be above reproach
2. Youth workers will treat every person with respect, loyalty, patience, integrity, courtesy, dignity, and consideration
3. They will follow the reasonable directives of Kairos leaders and carry out responsibilities given to them to the best of their abilities
4. They will be conscientious with the money, property, and possessions of Kairos and others
5. They will take appropriate concern for the health and well-being of minors and adults involved in the event/program
6. They will attend the training that is pertinent to their responsibilities
7. They will attend events to which they are assigned unless their absence has been approved by their supervisor
8. They will uphold confidentiality: youth workers will uphold the confidential nature of the information to which they are privy. They will not disclose confidential information to those who do not need to know it
9. Youth workers will not be alone in private with a minor
Inappropriate Conduct While Serving Youth
1. Sexual Contact/Pornography
  a. Youth workers will not touch or relate to minors in a sexual or inappropriate manner
  b. While serving, youth workers will not have intimate physical contact with another adult: for example., fondling, prolonged kissing/hugging
  c. Youth workers will not show or distribute pornographic materials
2. Harassment/Bullying
  a. While serving, youth workers will not act in ways that cause harm or humiliation
  b. They will not ridicule, threaten, make degrading remarks, or make comments of a sexual nature
  c. They will not use profanity, make sexually explicit statements, or tell inappropriate stories or jokes
  d. They will not initiate unwelcome physical contact or use corporal punishment such as hitting, spanking, shaking, or slapping
  e. They will immediately stop a behavior when they receive reasonable input that it is inappropriate or causes harm
3. Romantic Relationships: youth workers will not initiate or engage in a romantic relationship with another adult or minor during a youth program or event
4. Drugs/Alcohol/Tobacco
  a. Youth workers will not use, possess, or be under the influence of alcohol or recreational/illegal drugs while serving at a youth program or event
  b. Youth workers will not smoke or use tobacco products while serving a child/youth program or event
Reporting Improper Behavior, Abuse, Suspicion of Abuse
1. Youth workers should report any improper behavior (for example, violations of our Code of Conduct) to the supervisor in charge of the event/program
2. Youth workers should immediately report any abuse or suspected abuse to the supervisor in charge of the event/program
3. When called upon, youth workers need to cooperate fully in civil or community investigations of abuse
4. Some youth workers may be mandatory reporters under Michigan law due to their professional occupation (for example, doctors, teachers, social workers). Kairos encourages those who believe they are mandatory reporters to comply fully with the law
Eligibility for Service Policy
Kairos youth workers must have been participating for at least 6 months in the formative pastoral care of a community or outreach affiliated with The Sword of the Spirit. If you need an exception to this policy, choose "No" here and we will contact you about our exception process.
Are you eligible for service?*

Yes, I have been in SOS community or outreach pastoral care for 6 monthsNo, I need an exception
Signature*

Clear
Use your mouse or finger to draw your signature above
Printed Name*

First NameLast Name
Today's Date*

MonthDayYear
Cost
Payment Preference*

Pay by credit cardPay by checkMy youth group is handling my payment
Make the check out to: The Sword of the Spirit

In the memo line write: YES Retreat and the names of the people you're paying for

Mail to:
Attn: YES Retreat
Kairos
1502 River Terrace
East Lansing, MI 48823

Please note: If you pay after March 15, you will owe an additional $50.00 as a late fee. If your payment is not received by March 15, we will cancel your registration.

Should be Empty:

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

YES Staff Registration Form

Part 1 of 4: YES Retreat Information

Part 2 of 4: Staff Information

Part 3 of 4: Medical Information

Part 4 of 4: Consent and Payment