VBS Youth Volunteer (Grade 6-12) Registration

Youth Volunteer #1 Full Name:

Youth Volunteer #1 Birthdate:

Youth Volunteer #1 Gender:

Youth Volunteer #1 school grade for upcoming school year:

Youth Volunteer #1 Available Days:

Any allergies, medical conditions, or special needs?

Physician's Name and Phone #:

Youth Volunteer #2 Full Name:

Youth Volunteer #2 Birthdate:

Youth Volunteer #2 Gender:

Youth Volunteer #2 school grade for upcoming school year:

Youth Volunteer #2 Available Days:

Any allergies, medical conditions, or special needs?

Physician's Name and Phone #:

Youth Volunteer #3 Full Name:

Youth Volunteer #3 Birthdate:

Youth Volunteer #3 Gender:

Youth Volunteer #3 school grade for upcoming school year:

Youth Volunteer #3 Available Days:

Any allergies, medical conditions, or special needs?

Physician's Name and Phone #:

Child #4 Full Name:

Youth Volunteer #4 Birthdate:

Youth Volunteer #4 Gender:

Youth Volunteer #4 school grade for upcoming school year:

Youth Volunteer #4 Available Days:

Any allergies, medical conditions, or special needs?

Physician's Name and Phone #:

Family Email:

Family Phone:

Street Address, City, State, Zip:

Registered member of SAtG?

Yes

No

If not a member, what parish are you a member of?

Emergency Contact #1 First and Last Name:

Relationship:

Phone Number:

Emergency Contact #2 First and Last Name:

Relationship:

Phone Number:

My child/children has/have permission to volunteer at Vacation Bible School at St. Albert the Great Parish. I have reviewed the volunteer code of conduct with my child and agree to the guidlines as well. I agree on behalf of myself and my child's other parent, my child or our heirs, successors and assigns, to hold harmless St. Albert the Great Parish, the Diocese of Knoxville, its officers, directors and agents, the archdiocese of Louisville, chaperones or representatives associated with the event, arising from or in conjunction with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the Diocese of Knoxville, Archdiocese of Lousiville, chaperones or representatives associated with the event of reasonable attorney fees and expenses arising in connection therewith. In the event of an emergency, I hearby give permission to treat and transport my child to the hospital for emergency medical treatment. I wished to be advised prior to any further treatment by hospital or doctor. Type name and date here for electronic signature

VBS Youth Volunteer (Grades 6-12) Registration

VBS Youth Volunteer (Grades 6-12)

7200 Brickey Lane

Knoxville, TN 37918

(865) 689-7011