VBS Volunteers - Teens | St. Joseph's Catholic Church

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

T-Shirt Size (Adult Sizes) REQUIRED Please fill out this field.

Contact Information

Street Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

School Information

Name of School REQUIRED Please fill out this field. Please enter valid data.
Grade Level (as of Fall 2023) REQUIRED Please fill out this field. Please enter valid data.

Emergency Contacts

1ST EMERGENCY CONTACT
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
2ND EMERGENCY CONTACT
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Activities

We will attempt to accomodate your request; however, spots are limited for each activity.
Preferred Activities REQUIRED Classroom Arts & Crafts Office Nursery Music Snacks Sports Please fill out this field.

RELEASES

Media Release

I, the adult listed above, or a parent/guardian of the above listed youth volunteer, hereby grant permission to use my/my child’s picture, video image, and any artwork created during St. Joseph VBS on the church’s website, videos, publications, diocesan newspapers, and any of the church’s publicity information, newsletters, and bulletins.
Do you accept? REQUIRED I accept I do not accept Please fill out this field.
Signature:
DISCLAIMER: By typing your name below, you are signing this release electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Medication & Medical Release

Medication: The Office of Religious Education will not dispense any medication. Students may not have any medication in their possession during PREP classes except metered dose asthma inhalers, epinephrine auto-injectors (epi-pens) or epinephrine inhalers prescribed by their physician. If your child needs to carry an asthma inhaler, epi-pen, or epinephrine inhaler, please contact the Office of Religious Education prior to the beginning of the PREP class year.

Medical Release: By agreeing with this medical release: I hereby warrant, to the best of my knowledge, that my children listed in this St. Joseph’s Catholic Church PREP registration form, are in good health, and I assume all responsibility for the health of these children. In the even of an emergency, I hereby give permission to St. Joseph’s Catholic Church and the Diocese of St. Augustine employees, volunteers, or representatives, to seek medical treatment for these children. In the event any contacts listed on this form cannot be reached in an emergency, I hereby give permission to the physician selected by St. Joseph’s Catholic Church/Diocese of St. Augustine employees, volunteers, or representatives, to hospitalize, secure proper treatment for, and to order any injections, anesthesia and/or surgery for these children. In the event it comes to the attention of St. Joseph’s Catholic Church/Diocese of St. Augustine employees, volunteers, or representatives, that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, or diarrhea, all contacts listed on this form will be called until someone is reached who can pick up this child.
Do you accept? REQUIRED I accept I do not accept Please fill out this field.
Signature:
DISCLAIMER: By typing your name below, you are signing this release electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Assumption of Risk & Waiver of Liability Relating to COVID

Diocese of St. Augustine

The novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly through person-to-person contact. As a result, federal, state, and local governments, and federal and state health agencies, recommend social distancing and have, in many locations, prohibited the congregation of groups of people. St. Joseph Catholic Church has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you or your child(ren) will not become infected with COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending programs offered by the parish, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the parish may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, coaches, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at any parish sponsored programming (“claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless St. Joseph Catholic Church and the Diocese of St. Augustine, and all of their current, former, and future agents, representatives, religious, and employees and related entities (collectively, “the Diocese”) of and from the claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the Diocese, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any parish program.
Do you accept? REQUIRED I accept I do not accept Please fill out this field.
Signature:
DISCLAIMER: By typing your name below, you are signing this release electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Payment Information

Fee: $10 (for T-shirts, snacks, and drinks)
Payment Type REQUIRED Check Cash Please fill out this field.
If Check, name on your check & check #: Please enter valid data.

Please drop off your payment at Cody Center, or mail it to St. Joseph Catholic Church, Attn: VBS, 11730 Old St. Augustine Rd, Jacksonville, FL 32258.

Comments

Confirmation Email Please enter an email address.

VBS Volunteers - Teens

Volunteer Requirements

teen volunteer
registration form