2019 VBF: Youth Online Registration

Chelmsford Catholic Collaborative
Vacation Bible Fun hosted at St. John the Evangelist
August 5 - 9, 2019
8:00 am - 1:30 pm

YOUTH VOLUNTEER APPLICATION
Youth in 6th grade (entering 7th in the fall of 2019)
through 17 years of age

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Youth Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

NOTE: if you will be 18 before VBF week begins, please register as an Adult volunteer

Gender REQUIRED male female Please fill out this field.

Grade to be Completed in June 2019 REQUIRED Please fill out this field.

T-Shirt size REQUIRED Please fill out this field.

NOTE: Volunteers who submit this form AFTER July 13, 2019 will NOT be elilgible to receive a VBF t-shirt.

Name to Appear on Name Tag REQUIRED Please fill out this field. Please enter valid data.

Siblings Attending VBF REQUIRED Please fill out this field. Please enter valid data.

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Parent Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

Address Line 2 Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Home Phone Number Please enter a phone number.

Mobile Phone Number Please enter a phone number.

Parent Email REQUIRED Please fill out this field. Please enter an email address.

Youth Email REQUIRED Please fill out this field. Please enter an email address.

How Would you like to Receive VBF updates? REQUIRED home phone mobile phone parent email Please fill out this field.

Would you like Updates sent to Youth email as well? REQUIRED yes no Please fill out this field.

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Emergency Contact Person REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to Youth REQUIRED Please fill out this field. Please enter valid data.

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Any Medical Conditions we Need to be Aware of? REQUIRED Please fill out this field. Please enter valid data.

Does Your Child Have any Food Allergies? REQUIRED Please fill out this field. Please enter valid data.

Does Your Child Have any Medical Allergies? REQUIRED Please fill out this field. Please enter valid data.

Will Your Child be Bringing Medication with Him/Her? yes no

If Yes, Please List

Name of Heath Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.

Health Insurance Policy Number REQUIRED Please fill out this field. Please enter valid data.

Name of Family Doctor REQUIRED Please fill out this field. Please enter valid data.

Family Doctor Phone Number REQUIRED Please fill out this field. Please enter a phone number.

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Which Days you can Volunteer? REQUIRED Monday Tuesday Wednesday Thursday Friday Please fill out this field.

Please Rate your Work Interest from 1 to 7...
When picking an area in which to work, note that the 'odds and ends' means you many be asked to do various tasks throughout the week. These may be, but are not limited to, a fill-in vbf staff member, video, photos, decoration keeper, etc.

group guide Please enter an integer (number).

games Please enter an integer (number).

snacks Please enter an integer (number).

crafts Please enter an integer (number).

bible drama REQUIRED Please fill out this field. Please enter an integer (number).

odds and ends Please enter an integer (number).

wherever needed REQUIRED Please fill out this field. Please enter an integer (number).

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MEDICAL AND LIABILITY RELEASE

I hereby give permission for my child to participate in Vacation Bible Fun on August 6 thru August 10 2018 at St John the Evangelist Parish, North Chelmsford, MA 01863. I understand and agree to the following guidelines:

In case of an emergency, I understand that every effort will be made to contact the undersigned.
In the event the undersigned cannot be contacted I give permission for my son/daughter to be evaluated, diagnosed, treated and/or medicated by licensed medical personnel.
I give permission for the release of any medical records, which I have provided St John the Evangelist Parish, to medical personnel in case of illness. Further, I agree to accept any and all financial responsibility as a result of scheduling such treatment

I hereby release the Roman Catholic Archdiocese of Boston, a corporation sole, its agents, servants and employees, its priests, in addition to St John the Evangelist Parish Staff and/or volunteers from any and all liabilities in that my son/daughter sustains injury or medical care/treatment is provided.

I understand that the parish will not be held liable if my son/daughter fails to cooperate with these guidelines which remarks in immediate dismissal from the program. I will be responsible for any costs or other requirements for immediate transportation home.

By checking this box and typing my name below, I am stating that I fully agree and accept the terms of the Medical and Liability Release. REQUIRED I accept Please fill out this field.

Enter First and Last Name REQUIRED Please fill out this field. Please enter valid data.

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PHOTOGRAPH and VIDEO RELEASE

I hereby give permission for my child to be photographed and video'd during Vacation Bible Fun 2019 by staff and volunteer chaperones of Chelmsford Catholic Collaborative. These photographs and videos may be used reasonably by the Chelmsford Catholic Collaborative in all publications, including electronic publications, and/or in audio visual presentations, promotional literature, advertising or in similar ways such as in social media channels directly owned by the Chelmsford Catholic Collaborative.

By checking this box and typing my name below, I am stating that I fully agree and accept the terms of the Photograph and Video Release. REQUIRED I accept Please fill out this field.

Enter First and Last Name REQUIRED Please fill out this field. Please enter valid data.

2019 VBF: Youth Online Registration

2019 VBF : ROAR
August 5-9, 2019

Signups will beginning March 15th.

2019 VBF: Youth Online Registration

2019 VBF : ROAR August 5-9, 2019

Signups will beginning March 15th.

2019 VBF : ROAR
August 5-9, 2019