St. John the Evangelist
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VBS Teen Volunteer Form
*
Indicates required field
Youth Name
*
First
Last
Birthdate
*
grade in fall 22
*
Youth T-shirt size (adult sizes)
*
S
M
L
XL
Parent Email
*
Parent Phone Number
*
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
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.
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:
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.
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.
signature of parent/guardian
*
date
*
preferred Phone Number
*
home Address
*
Line 1
Line 2
City
State
Zip Code
Country
other emergency contact
*
relationship to youth
*
Phone Number
*
youth's medications
*
Allergies/Chronic conditions (e.g. epilepsy, ADHD, diabetes)
*
medical insurance company
*
policy number
*
member's name
*
Phone Number
*
child's doctor
*
Phone Number
*
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
*
Indicates required field
child 1 name
*
First
Last
grade in fall, 2022
*
child 2 name
*
First
Last
grade in fall, 2022
*
child 3 Name
*
First
Last
grade in fall, 2022
*
child 4 Name
*
First
Last
grade in fall, 2022
*
Name of parent/guardian 1
*
First
Last
relationship to student
*
Phone Number
*
Email
*
Name of parent/guardian 2
*
First
Last
relationship to student
*
Phone Number
*
Email
*
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):
Crafts, Games, Bible Story, Snack Activity, Video Activity
*
Other Opportunities
Number preference (1 being first choice and 5 being last choice):
Small Group/Crew Leaders, Song Leader, Prepare Snacks, Set Up (Thurs, June 16 & Fri, June 17 (Time TBA), Tear Down (June 24, 12-2pm)
*
Vacation Bible School
Permission, Release and Medical Power of Attorney Form
June 20 - June 24, 202
(Completed by Parent or Guardian)
Name
*
First
Last
School
*
Phone Number
*
Email
*
Birthdate (DD/MM/YYYY)
*
Grade
*
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
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.
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:
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.
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.
*
Please type your full name below.
parent's home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Parent's employment
*
Work Phone Number
*
work Address
*
Line 1
Line 2
City
State
Zip Code
Country
other emergency contact
*
First
Last
relationship
*
Phone Number
*
Child's medications
*
allergies/chronic conditions (e.g. epilepsy, diabetes)
*
medical insurance company
*
policy number
*
member's Name
*
First
Last
Phone Number
*
child's doctor
*
Phone Number
*
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
signature of parent/guardian
*
date (DD/MM/YYYY)
*
Submit
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
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
Jr. High Summer Camp
Parish Life
Events
>
Trunk N Treat Registration
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