Vacation Bible School Staff Registration Form
Please fill out this form and click submit.
Name
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Youth or Adult Staff
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Please select one option.
Youth
Adult
Date of Birth
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Age as of June 1, 2019 (if under 18). If you are an adult, please put "n/a".
*
T-Shirt Size
*
Please list any medical concerns, conditions, or prescriptions. If none, please state "none".
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Please list any food allergies. If none, please state "none".
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Is there anything you would like to share that will help us serve your family better? Any other comments or concerns? If none, please state "none".
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Parent/Guardian's Name (if under 18). If an adult, please put "n/a".
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Phone Number (if under 18, please put parent/guardian's phone number).
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E-mail (if under 18, please put parent/guardian's e-mail).
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This address will receive a confirmation email
Emergency Contact's Name
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Emergency Contact's Phone
*
Emergency Contact's Relationship
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Name(s) and contact information for person(s) authorized to pick up the youth staff. If an adult, please put "n/a".
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What three areas are you interested in serving?
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I authorize leaders of St. Mary's Episcopal Church to request medical care in the event of an emergency:
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Please select one option.
Yes
No
I grant permission for St. Mary's Episcopal Church to record media, and use said media for non-commercial purposes. This media may be in the form of a photograph, film, audio, video, digital, or other electronic format, and may be used on the St. Mary's website or Facebook page. Published documents will not include full name or personal information.
*
Please select one option.
Yes
No
If under 18, please list two adult references and their contact numbers. If over 18, please put n/a.
*
Submit
Description
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