If this is an email of someone in grade 6-12 then you are authorizing me to send information to them about our 2019 Vacation Bible School week. I will also send the same email to the adult email listed on this form.
This would be used during VBS week
June 23-27 2019
Family Doctor Name and Phone Number
(only used in case of emergency)
Name of Insurance Company/Policy, Group, or Contract Number (only used in case of emergency)
If you are 18 years of age or older-have you taken the Protecting God's Children Session?
By checking the box below you give permission for your child to help at the 2019 VBS event from June 23-27 in the evening from 5:45-about 8:30PM.
Which days will you be able to volunteer? Check all the days you will be here to volunteer.
Unfortunately, if I receive this after May 24 I can not guarantee a T-Shirt for you.
As the parent or legal guardian, of the youth listed on this form, I hereby authorize first aide/medical treatment in the event of an emergency, which may endanger her/his life, cause disfigurement, physical impairment, or undue discomfort if delayed. It is understood that efforts will be made to contact the person listed on this form as soon as reasonably possible. In the event that the aforementioned requires my authorization for treatment and I cannot be reached in an emergency, I hereby give my permission to the physician selected by the activity leader to hospitalize, secure medical treatment, and/or order an injection, anesthesia or surgery for the aforementioned as deemed necessary. I understand all reasonable safety precautions will be taken at all times by the parish and its agents during youth programing and events. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold St. Sebastian Church, its leaders, employees, drivers, volunteers, or the Roman Catholic Diocese of Grand Rapids liable for damages, losses, diseases, or injuries incurred by the aforementioned.
As legal guardian, I understand that photos and videos of participants may be taken during this week. I am the parent/legal guardian of those listed on this form and I hereby approve and consent to the use of his/her photo or video image and name to be used for promotional purposes (bulletin, church website, newspaper, etc.).