VBS Volunteer Registration 2022

If you are under the age of 18 please have your parent or guardian fill out this form.

Dear KOG Friends and Family,

This Volunteer Registration Form is for all adults and youth who will at least be entering the 7th grade in the fall school year of 2022.

Fill out one form per volunteer and click submit.

Please mark your calendar for Sunday, July 17th from noon to 2:30 pm for our Volunteer Training and Risk Management Workshop. This is MANDATORY in order to work with KOG Kids and Youth!

In just a few weeks, you will receive an email with more information of dates and times to all of our events leading up to VBS, including the week of VBS itself.

Thank you for your commitment to KOG Kids! Without you there would be no VBS!!!

Please don't hesitate to reach out with any questions or concerns!

Amanda Pulos
Director of Youth and Children's Ministry
kogkids@gmail.com
(714)604-3373

Volunteer's Name

Grade in Fall (if applicable)

Date of Birth

This address will receive a confirmation email

Phone

Address

Do you have a home church?

Yes No Other

Where do you worship currently?

How would you like to help prepare the weeks before VBS?

What do you believe would be the best use of your time and talents during the week of VBS?

I am 18 years of age or Older

Yes No

If you have marked "Yes" You will be asked to fill out a Criminal Record Check. This is mandatory for all King of Glory Volunteers over the age of 18.

MEDICAL AUTHORIZATION, RELEASE OF LIABILITY AND PERMISSION

MEDICAL RELEASE STATEMENT AND WAIVER

I hereby authorize King of Glory Lutheran Church, into whose care Minor has been entrusted, to consent to medical or dental treatment or care for Minor under Section 6910 of the California Family Code. The authority granted by this authorization includes the authority to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, or hospital care under the general or special supervision and upon the advice of or to rendered by a physician or surgeon licensed under the Medical Practice Act and to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment or hospital care by a dentist licensed under the Dental Practice Act. It is understood that this authorization is given in advance of any specific diagnosis or treatment being required, and is given to provide authority and power to render care which the aforementioned physician, in his or her best judgment may deem advisable.

I further authorize King of Glory Lutheran Church to receive physical custody of Minor under Section 1283 (a) of the California Health and Safety Code upon completion of any treatment, and I specifically instruct any treating health facility to surrender the physical custody of Minor to King of Glory Lutheran Church of Fountain Valley.

RELEASE OF LIABILITY:

I understand the nature of the events and do hereby release, acquit, and forever discharge, on behalf of myself and Minor, King of Glory Lutheran Church, its sponsors, agents, servants, successors, heirs, executors, and administrators, from any and all claims, actions (or cause of action), or expenses whatsoever, which the undersigned now has or may hereafter accrue on account of or in any way growing out of any known and unknown, foreseen and unforeseen bodily injuries and property damage and the consequences thereof resulting or to result from any accident, casualty or event which has or may occur during activities sponsored by or under the auspices of said King of Glory Lutheran Church.

The authorization is given pursuant to Section 25.8 of the Civil Code of California and remains effective until revoked.

PERMISSION AND AUTHORIZATION TO CONSENT TO TREAT A MINOR:

I, ____________________________________am the parent, legal guardian, or the caregiver who is a relative of, and who, under Section 6550 under the California Family Code, may authorize medical and dental care for_____________________________, (Minor's name) I give permission for Minor to take part in any of the events held with King of Glory Lutheran Church.

Mother or Legal Guardian's Name:

Address

Phone

Father or Legal Guardian's Name:

Address

Phone

Health Information- Please check any that apply and please describe and/or date appropriately:

Do you have any health concerns or special needs?

Yes No

If you marked yes, please explain

Allergies:

Dietary Restrictions:

Asthma (Inhaler instructions):

Immunizations:

Tetanus MMR TB Diphtheria Polio

Pertinent Health or Medication Information:

Health and Accident Insurance Information

Phone Number, Policy Number and Group Number

Youth's Physicians Name and Phone Number

In the event of an emergency, in which I am not available, please notify:

Name and Relationship

Phone

Photo Consent

Photographs may be used for the following items:

KOG page, church marketing materials such as Fountain Valley Living or other local magazines, brochures, flyers, church newsletters, and/or other items to help promote KOG Church and Preschool.

Names will never be identified.

By marking yes I consent that photographs of my child and/ or of myself may be used in the above mentioned ways for KOG preschool or church publicity and marketing.

YES NO

By checking I agree I am stating that I have read all of the form above and have provided all of the necessary information.

I Agree

VBS Volunteer Registration 2022

Description

Please Fix the Following