St. John the Evangelist
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    VBS Teen Volunteer Form


    ​This Medical Release Form will cover all activities of St. John Parish Vacation Bible School from June 20 – June 24, 2022.
    ARCHDIOCESE OF CINCINNATI
    RELEASE AND INDEMNIFICATION AND MEDICAL POWER OF ATTORNEY
    1. I, the lawful parent or guardian of ___________________________(the “child”), give permission for my child to participate in the activity described on the reverse side, and release from all liability and indemnify the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney fees, arising out of any injury or illness incurred by my child while participating in or traveling to or from the activity.
    2. I agree to instruct my child to cooperate with the Archbishop or his agents in charge of the activity.
    3a.   I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical emergency occurs during the activity or related travel:
    1. To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for the best interest of the child.
    2. I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.
    3b.   The powers and authority granted herein may be revoked by me by written notice delivered to the Archbishop or his agents who are then acting or who have previously acted hereunder.  Without such written notice, this power of attorney shall not be affected by my disability, incapacity or adjudicated incompetence.  This power of attorney shall lapse automatically at the end of above said time period.
    4.     I agree that the Archbishop or his agents may use my child’s portrait or photograph for promotional purposes and office functions, and hereby release the Archbishop and his agents from any liability resulting from such use.

    I have carefully read this statement, and my signature acknowledges that I fully understand its content and meaning.


    Activity Information
     
    Church Agency:                       St. John the Evangelist Parish
    Program:                                 Vacation Bible School
    Registration Fee:                     Free for Teen Volunteers (grades 7 & up, Fall, 2022)
    Meeting Dates & Time:           June 20 – June 24, 2022, 8:30am- 12:00pm
    Activity Location:                    St. John the Evangelist, Parish Education Center
                                                    9080 Cincinnati-Dayton Rd. West Chester, OH 45069
    Activities Involved:                  Music, Skits, Games, Snacks, Large & Small Group Gatherings
    Event Leader:                          Mary Montour, Pastoral Associate, Children’s Faith Formation
    Phone Contact:                       513-755-4973, or 513-777-6433, x.118, or Cell: 513-708-2654​
Submit

    VBS 2022 Online Registration Form


    Please consider giving your time and talent to the young people of our parish! It takes many volunteers for VBS to be a success. All materials are provided, and lessons, skits, and songs are scripted. Teens going into 7th grade and older are welcome to join the adventure! Questions? Contact Mary Montour, mmontour@stjohnwc.org or (513) 777-6433, x.118

    Session Leader

    ​Number preference (1 being first choice and 5 being last choice):

    Other Opportunities

    ​Number preference (1 being first choice and 5 being last choice):

    Vacation Bible School
    Permission, Release and Medical Power of Attorney Form
    June 20 - June 24, 202

    ​(Completed by Parent or Guardian)
    ​This Medical Release Form will cover all activities of St. John Parish Vacation Bible School from June 20 through June 24, 2022.  This completed, signed form must accompany Vacation Bible School registration form and payment.
     
    ARCHDIOCESE OF CINCINNATI
    RELEASE AND INDEMNIFICATION AND MEDICAL POWER OF ATTORNEY
    1. I, the lawful parent or guardian of ___________________________(the “child”), give permission for my child to participate in the activity described on the reverse side, and release from all liability and indemnify the Archbishop of Cincinnati (“the Archbishop”), both individually and as trustee for the Archdiocese of Cincinnati and all parishes within the Archdiocese, and their officers, agents, representatives, volunteers, and employees from any and all liability, claims, judgments, cost or expenses, including attorney fees, arising out of any injury or illness incurred by my child while participating in or traveling to or from the activity.
    2. I agree to instruct my child to cooperate with the Archbishop or his agents in charge of the activity.
    3a.   I appoint the Archbishop or his agents who are acting as leaders of the activity as my attorney in fact to act for me in my name and my
            behalf, in any way that I would act if I were personally present, with respect to the following matters if any injury, illness or medical         emergency occurs during the activity or related travel:
    1. To give any and all consents and authorizations to any physicians, dentist, hospital or other persons or institutions pertaining to any emergency medications, medical or dental treatments, diagnostic or surgical procedures or any other emergency actions as our attorney shall deem necessary or appropriate for the best interest of the child.
    2. I understand that the agents of the Archbishop will make a reasonable attempt to contact me as soon as possible in the event of a medical emergency involving my child.
    3b.   The powers and authority granted herein may be revoked by me by written notice delivered to the Archbishop or his agents who are then acting or who have previously acted hereunder.  Without such written notice, this power of attorney shall not be affected by my disability, incapacity or adjudicated incompetence.  This power of attorney shall lapse automatically at the end of above said time period.
    4.     I agree that the Archbishop or his agents may use my child’s portrait or photograph for promotional purposes and office functions, and         hereby release the Archbishop and his agents from any liability resulting from such use.
    Please type your full name below.

    Activity Information

    A.            On-Going Program
    Church Agency    St. John the Evangelist Parish          Program or Group   Vacation Bible School
    Starting Date    Monday, June 20, 2022                        Ending Date    Friday, June 24, 2022
    Registration Fee     $15.00 per child                
    Usual Location     St. John Education Center               
    Usual time    9:00am – 12:00pm
    Routine Activities           Music, Skits, Games, Snacks, Large & Small Group Gatherings         
    Group Leader   Mary Montour, Pastoral Associate, Children’s Faith Formation
    Telephone No.  513-755-4973, or, 513-777-6433, x.11
Submit
Tri-County Catholics
Family of Parishes

St. Gabriel | St. John | St. Michael
9080 CINCINNATI-DAYTON RD 
WEST CHESTER, OH 45069-3129 
PARISH OFFICE: (513) 777-6433
  • Home
  • About
    • Bulletin
    • Forms >
      • Employment Application
      • Parish Registration Form
      • Parishioner Info Update Form
      • Space Request Form
      • Stewardship Form
      • Stewardship of Treasure Form
    • Mass Times
    • Online Streaming
    • Staff Directory
    • St. John History
  • Faith Life
    • Becoming Catholic
    • Adult Faith Formation >
      • Bible Studies
    • Parish School of Religion >
      • PSR Calendar
      • Child Protection Information
      • Early Childhood
      • Families with Special Needs
      • Home Study
      • PSR Classes
      • Vacation Bible School
    • Liturgy & Music
    • Prayer
    • Sacraments >
      • Anointing of the Sick
      • Baptism
      • Confirmation
      • First Eucharist
      • First Reconciliation
      • Marriage
    • Youth Ministry >
      • HSYM Permission Form
      • JHYM Permission Form
      • Campton Mission
  • Parish Life
    • Events
    • Family Festival
    • Boy Scouts
    • Girl Scouts
    • Justice and Peace
    • Knights of Columbus
    • Mind Body Spirit
    • Pastoral Advisory Board (PAB)
    • Spirited Seniors
  • Pastoral Care & Outreach
    • Pastoral Care
    • Outreach
  • Finances
    • Online Giving
    • Parish Wish List