Youth Volunteer Application Form 2025

Youth Volunteer Application Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
Gender
Grade Entering Fall of 2025
Service Hours Needed?
School attending
Father's/Guardian's Name

First NameLast Name
Mother's/Guardian's Name

First NameLast Name
Parish personnel have permission to photograph my child and use at their discretion.
Volunteer

I understand that in applying for a volunteer position at St. Barnabas Parish, I agree to follow the directions given by the catechist and focus my attention on service to the children.
Signature of Volunteer*

Clear
Parent/Guardian

My child, as named above, has permission to serve as a volunteer with the St. Barnabas Parish School of Religion program.
Signature of Parent/Guardian*

Clear
Does your child have any allergies?
Emergency Medical Authorization Form

PART I or PART II must be completed.
PART I (To Grant Consent)
In the event reasonable attempts to contact me at   Phone Number or First Name   Last Name  (other parent/guardian) at    Phone Number have been unsuccessful, I hereby give my consent for:

(1) the administration of any treatment deemed necessary by Dr. Preferred Doctor at   Phone Number or Dr.    Preferred Dentist    at    Phone Number or in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and

(2) the transfer of the child to   Preferred Hospital or any reasonably accessible hospital.
This authorization does not cover any major surgery unless the medical opnions of two (2) other licensed physicians or dentists concur in the necessity for such surgery and concurrence is obtained before the surgery is performed.
Signature

Clear
(Do Not Complete Part II if You Completed Part I)

PART II (Refusal to Consent)
I do NOT give my consent for emergency medical treatment of my child. In the event of illness or emergency treatment being required, I wish the school authorities to take no action or to:
Signature

Clear
St. Barnabas Parish

9451 Brandywine Road

Northfield, OH 44067
Should be Empty:

Youth Volunteer Application Form

Emergency Medical Authorization Form