VBC Volunteer Registration

Name
Address
Phone
Email
Congregation (if any)

HERE’S HOW I WANT TO HELP!
Rank three jobs in order of your preference. Please only write down jobs that you are happy doing.

My #1 choice is:
On these days (check all that apply):

My #2 choice is:
On these days (check all that apply):

My #3 choice is:
On these days (check all that apply):

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FOR ALL AGES: EMERGENCY INFORMATION
In case of emergency, please contact

Emergency Contact #1
Phone

I have the following allergies of physical limitations and/or am taking the following medications (If none, write here):

FOR THOSE UNDER 18:

Heath Insurance Company
Policy Number

PERMISSION TO ENGAGE IN VACATION BIBLE CAMP ACTIVITIES:I/We, the parents/legal guardians of the child names above hereby grant permission for our child to participate in Vacation Bible Camp. I/we take full responsibility for the actions of our child and relieve all adults at Epiphany Parish of Seattle of any liability in conjunction with these activities.

PHOTOGRAPHIC IMAGE RELEASE:I/We give permission for the child names above to be photographed and/or videotaped during the week and for the images and/or recordings to be published, reproduced, or distributed by Epiphany Parish of Seattle in all outlets, including, but not limited to, television, newspapers, Internet, church publications, and promotional materials without liability or limitation on my or my minor’s part. Furthermore, such use shall be without payment of fees, royalties, special credit, or other compensation.

EMERGENCY MEDICAL CONSENT: I/We give permission, if I/we cannot be contacted, for our child to be treated at any hospital or licensed health care facility by any physician when deemed immediately necessary or advisable by the physician to safeguard our child’s health. I/We waive the right of informed consent to such treatment.

I have read all the appropriate sections above.
Signature (of Parent/Guardian if volunteer is under 18)