VBS Volunteer Form

VBS 2024 Volunteers

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Child's Name *

Child's Age *

Date of birth *

Gender *

T-Shirt Size *

Adult S

Adult M

Adult L

Adult XL

Parent / Guardian name: *

Country *

Address 1 *

Address 2

City *

State *

Address *

Home phone: *

Cell phone:

In case of emergency (when the parent/ guardian cannot be reached), pleas contact: *

Telephone: *

Relationship to child: *

The undersigned agree to indemnify and hold the Dioces of Stockton and Sacred Heart Catholic Church, its respective members, directors, emplyees and agents (collectively, the "Indemnities") harmless from and against any claims, demands, actions, lawsuits and liabilities, including attorney fees and expenses sustained by the Indemnities as a result of negligent, willful or intentional acts of the undersigned and/or participant. If the participants is under the age of 18 uears old, I (we), the parent(s) or legal guardian(s) of the participant do hereby grant permission for our child to participate in the Vacation Bible School activities. I, the participant, and/or parent(s) or leagal guardian(s) of a participant do hereby give permission to the "Indemnities" to take a said participant to a doctor or hospital and hereby authorize medical treatment, including but not limited to emergency surgery and I (we) fully and completely assume all responsibility for all medical bills.

Medical Insurance *

Yes

Insurance Co: *

Policy # *

Physician Name: *

Physician Phone: *

Signature of parent/guardian *

Leave this field blank