Youth VCS Volunteers - East Liberty Presbyterian Church

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This field is for validation purposes and should be left unchanged.
Youth Volunteer Information
For youth under the age of 18.
Name*
First Last
Preferred Pronouns (she/her, he/him, they/them)*
Email
What's the best phone number to reach you?*
Address*
Street Address Address Line 2 City State ZIP Code
What's your age?*
Please enter a number from 10 to 17.
What's your date of birth?*
Month
Day
Year
What grade did you most recently complete in school?*
Please enter a number from 5 to 12.
How will youth get to and from VCS each day?*
Please list the names of people who are authorized to pick youth up.
Who is your emergency contact?*
First Last
What is the best phone number to reach your emergency contact?*
Do you have any special needs or allergies? If so, please list them.

Youth Volunteer Permission Slip
To be completed by a parent or guardian
Photo Consent
I give East Liberty Presbyterian Church permission to use photos of the student listed on this form and to put the finished photos to any use (newsletter, bulletin boards, website) without limitations or reservation.
In Case of Emergency
I understand that every effort will be made to contact me. If I cannot be reached, I hereby give the East Liberty Presbyterian Church Vacation Church School Workers the permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary by the Vacation Church School (VCS) workers. I give permission for those administering emergency treatment to do so, using those measures deemed necessary. I absolve the VCS workers and East Liberty Presbyterian Church from liability in acting on my behalf in this regard so long as the VCS workers are not grossly negligent.
Parent or Guardian Name who is giving permission
First Last
Parent or Guardian's Email*
Parent or Guardian Cell Number
Parent or Guardian Work Phone Number
Parent or Guardian Home Phone Number
Second Parent or Guardian Name (optional)
First Last
Second Parent or Guardian Best Contact Number (optional)
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Register Youth to Volunteer at VCS