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We need all kinds of help making the week a success. Sign up using the form below.
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Indicates required field
Name
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First
Last
I am a/an...
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Adult
Youth - 6th grade
Youth - 7th grade
Youth - 8th grade
Youth - High School
Email
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Youth: please indicate which stipend you choose to recieve at the end of the VBS week.
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$100 cash
$150 trip/camp credit
Option 3
Phone Number
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Alternate Phone Number
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Volunteer Opportunities for VBS...
Please indicate your preference. Choose all that apply.
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Group guide: Preschool (adults only)
Group guide: K-1st
Group guide: 2nd-3rd
Group guide: 4th - 5th
Clerical (prior to VBS, flexible Mon-Thurs)
Snacks (9-11 a.m.)
Afternoon Rotations (12-1:30 p.m.)
Registration Desk (8:30-9:15 a.m.)
Car Line (8:30-9:15 a.m.)
Car Line (10:40-11:10 a.m.)
Car Line (1:40-2:10 p.m.)
General Support during VBS (ie. "I'm here. What can I do?")
If you are NOT available to volunteer for th entire week, please indicate the days you ARE available to assist in the areas you selected above.
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Monday 6/11
Tuesday 6/12
Thursday 6/13
Wednesday 6/14
Additional Volunteer Opportunities
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I will help decorate PRIOR to VBS.
I will help clean up AFTER VBS.
Nusery care will be provided during VBS for the children of volunteers. Please list the names and ages of children who will need nursery carew while you are volunteering.
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Health Insurance Information and Release
Policy Holder's Name
*
Insurance Company Name
*
Policy/Member Number
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Primary Physican's Name
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Primary Physician's Phone Number
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By my indication below, I consent to any ex-ray, examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care under the general supervision and upon the advice of or to be rendered by a physician, surgeon, or dentist licensed under the Medical Practice Act and Dental Practice Act. As parent or legal guardian, I am responsible for the health care decisions of my child and am authorized to consent to services to be rendered, and no other consent is required by law. I hereby give permission to the physician selected by the activities supervisory personnel then present to render medical treatment deemed necessary and appropriate by the physician or dentist. I will assume FULL FINANCIAL RESPONSIBILITY for care given.
I warrant and represent that I am eighteen years of age or over, and am fully aware of and understand the terms and legal consequences of the signing of this form. I intend my initials below to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Initials/Date
*
example: ABC/1-1-16
Parent/Guardian Initials/Date (if applicable)
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Submit
