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VBS Youth Volunteer Form (ages 11-17)

- Lifelong Faith Formation

Youth Volunteer Application Form
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Grade entering in Fall 2024 REQUIRED Please fill out this field. Please enter valid data.
- Age at time of VBS REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Female Male Please fill out this field.
- Staff t-shirt size (to borrow for the week): Youth M (10/12); Youth L (14/16); Youth XL (18/10); Adult S, Adult M, Adult L, Adult XL Please enter valid data.
- All youth (ages 11-17) are required to attend Youth Leadership Training prior to VBS. Are you able to attend on Saturday, June 15 from 9am-2pm at St. Mary Church Hall? REQUIRED Yes No Please fill out this field.
- Please check if you agree to abide by the following I will dress modestly and in accordance with the dress code. I will not wear clothing (including bags) with anti-Catholic propaganda or bad language.
- Student's Email Please enter an email address.
- Cell Phone Number Maximum 20 characters Please enter a phone number.
- Allergies/medications/chronic medical concerns REQUIRED Please fill out this field. Please enter valid data.
- Family Information
- Name of Parent/Guardian #1 Please enter valid data.
- Parent/Guardian #1 Phone number Maximum 20 characters Please enter a phone number.
- Parent/Guardian #1 Email Please enter an email address.
- Name of Parent/Guardian #2 Please enter valid data.
- Parent/Guardian #2 Phone Number Maximum 20 characters Please enter a phone number.
- Parent/Guardian #2 Email Please enter an email address.
- Home Parish/Church Please enter valid data.
- Medical Care Informtaion
- Primary Care Physician Please enter valid data.
- Health Insurance Name/Policy # Please enter valid data.
- Policy Holder Name Please enter valid data.
- Emergency Contact Informtaion
- Name Please enter valid data.
- Relationship Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- I request permission for my child to attend this event to be held at St. Joseph’s Church. I understand this event will take place under the guidance and supervision of responsible employees/volunteers from the Diocese of Portland and, if needed, give permission for my child to be evaluated, diagnosed, treated/medicated in accordance with standard medical practice by licensed medical personnel. I relieve the parish, diocese, and volunteer leaders of all responsibility and consequences that may arise because of this treatment. I will not hold the parish, diocese, or representative associated with this event responsible in the event of injury. If I cannot be reached in case of an emergency I give permission for the parish coordinator to act on my behalf. Further, I agree to accept any and all financial responsibility related to such care.
  
  I/my child agree to abide by all the rules as outlined in the Diocese of Portland Code of Behavior/Ethics.* The Diocese of Portland will not be liable if myself/my child fail to cooperate with said rules and any infractions may result in immediate dismissal from this event. I understand that I am legally responsible for the behavior of myself/my child.
  
  DIGITAL RELEASE: I hereby grant to the Diocese of Portland my consent without reservation to use, assign, convey, reproduce, copyright or publish my child’s name, voice, image, and/or likeness that arises from his/her participation in this event, whether still or motion pictures, audio or video tape, for promotional, instructional, business or any other lawful purposes, at the Diocese of Portland’s sole discretion.
  I Agree Please select this field.
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VBS Youth Volunteer Form (ages 11-17)

Youth Volunteer Application Form

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