Ashfield Farm VBS Jr Leader 2023

Thank you for considering giving your week to help make VBS happen! Jr. Volunteers are middle or high school students (age 12+) who will lead children, assist with activities and pitch in to create a fun, safe space for day campers!

This exciting day camp is put on by All Nations Church in collaboration with Ashfield Farm. Learn more about the program and others at ashfieldfarm.ca.

Monday July 3rd to Friday July 7th

Volunteers must be able to arrive by 9am and stay until 4pm

This form is intended to be completed with by the Jr. Volunteer and their parent/guardian.

Jr. Volunteer's Name*

First NameLast Name

Date of Birth *

Date

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

MaleFemaleOther

Parent / Guardian Name*

First NameLast Name

Phone Number of Parent/Guardian*

Format: (000) 000-0000.

Email of Parent/Guardian*

example@example.com

Email of Jr. Volunteer (if you have one)

example@example.com

Emergency Contact's Name*

First NameLast Name

Emergency Contact Relationship to Volunteer *

Emergency Contact's Phone Number*

Format: (000) 000-0000.

Alternate Phone Number Emerg Contact

Format: (000) 000-0000.

Do you have any allergies, chronic illness, or medical conditions? If yes, please provide more information and list any medications.*

Volunteer's Health Card Number

Leading a group of 5 - 10 young children in a pre-planned activitySwimming with childrenAssisting with handling horses and/or small animalsActing in skits or leading songs in front of a groupPraying with campersNone, of the above, but I could assist

Do you have a favourite activity at Ashfield Farm? (If you have been here before)

Do you have any related volunteer experience? For example, babysitting, helping with kid's ministry at church, assisting with horseback riding lessons?

Yes, keep me in the loop!No thanks

Medical Release and Authorization As Parent and/or Guardian of my child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Ashfield Farm and its affiliates including Directors, Leaders, and Farm Staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.*

I have read and accept the above Medical Release and Authorization Agreement

CANCELLATION POLICY

Cancellations for VBS prior to August 1st will recieve a refund minus a $50 administration fee. There is no cost to switch which week you are registered for, but the possibility to switch depends on available spaces in the week requestsed. Cancellations after July 1st will recieve a 50% refund. To cancel your registration please email hello@ashfieldfarm.ca.

INDEMNITY

1. I recognize the inherent risks of injury involved in any type of animal or farm activity. Animals do have minds of their own. No animal is a completely safe animal. If an animal is frightened or provoked it may divert from its training and act according to its natural survival instincts; which may include but not limited to: stopping short, changing direction or speed at its own will, shifting its weight, rearing, biting, bucking, kicking, or running from danger.

2. No lesson will be given unless this contract is completed in full.

3. In partaking in DAY CAMP at Ashfield Farm, I assume any such risk of injury and further, I voluntarily release Ashfield Farm, its instructors, managers, volunteers and agents from any responsibility on account of any injury I or my child or ward may sustain while receiving instruction or while riding in connection therewith, and I agree to indemnify and hold harmless Ashfield Farm, its instructors, managers, volunteers and agents on account of any such claim.

4. Likewise I accept full responsibility for myself and family on Ashfield Farm property.

5. Ashfield Farm and All Nations Church, its instructors, managers, volunteers and agents are not liable for an injury to, or the death of, a participant in farm or animals activities resulting from the inherent risks of such activities.

Accept

I (the parent or legal guardian of the child named on this form) grant Ashfield Farm my permission to use photographs and videos taken of my child while at Ashfield Farm while participating in programs and activities. I give my permission for photos or videos to be used by Ashfield Farm and/or All Nations Church for any legal use, including but not limited to copyright purposes, web content, illustration, and marketing or advertising. Furthermore, I understand that no royalty, fee, or other form of compensation is payable to me by reason of such use.*

I grant full permission to Ashfield Farm and/or All Nations Church for the use of my child's photos and videosI do not give permission, I prefer no videos or photos be taken of my child

ACCEPT

Signature

Medical Release & Authorization

Liability and Release Agreement Form

Photo & Media Permission Form