TRAINING DAY 1: July 13th

TRAINING DAY 2: July 20th

ADULT VOLUNTEER RETREAT: July 23rd

SET-UP DAYS: July 25th & 26th

CAMP DAYS: July 28th - August 1st
CAMP HOURS: 9:00am - 12:30pm

Registration is complete only when this form and Virtus certification is verified.

Adult's First Name *

Adult's Last Name *

Best Email for Updates *

Best Contact Phone Number *

I agree to terms & conditions provided by St. Mel Parish. By providing my phone number, I agree to receive text messages from VBS.

Home Address *

City *

Postal code *

Adult Volunteer's T-Shirt Size *

Are you available to serve as a volunteer all week? *

Yes

Please indicate which days you are NOT available to volunteer.

At St. Mel our top priority is the safety of all children. We require all adults that volunteer with children to be VIRTUS trained. Are you up to date on your VIRTUS Certification?

Please Upload Your Virtus Certificate

I hereby authorize the Parish to use the following personal information on the parish website and end of week VBS slideshow: *

Adult Medical Information

Dietary restrictions or Food Allergies our volunteers should be aware of: *

*If no dietary restrictions or allergies type N/A

Health Insurance Name *

Health Insurance Policy Number *

Medication Authorization: If I need to take medication while participating in this activity, I hereby give myself permission to self-administer medication in accordance with the Medication Authorization and Permission Form, and, if I cannot self-administer, I give permission to the responsible staff members to administer or to assist in the administration of my medication. I also give permission to the responsible staff members, chaperones, medical practitioners and medical facilities to use their judgement in obtaining and providing medical treatment for me should it become necessary to do so. I understand that health insurance benefits through the Location, if any, may have limited application, and that I am entirely responsible for the cost of all medical treatment provided to me. I agree to reimburse the Location for the cost of any medical treatment and related expense incurred.

Release of Liability: As a condition of participating in this activity, I hereby hold harmless, release and discharge The Roman Catholic Archbishop of Los Angeles, a corporation sole, Archdiocese of Los Angeles Education & Welfare Corporation and the Location, their respective agents and employees and any parent/volunteer/chaperone, from any and all liability, loss or claims for personal injuries, wrongful death or property damage that I may suffer as a result of participation in the activity described above.

I, the Adult Volunteer, have read this Authorization, understand the contents and am able to grant the rights and waivers it contains. I understand that the terms of this Authorization are contractual and not mere recitals. I am signing this document freely and voluntarily.

Sign Below: *

Clear