2025 VBS Youth Volunteer Form

2025VBS Youth Volunteer Form
TO BE HELD AT: Pohick Episcopal Church 9301 Richmond Highway Lorton, Virginia 22079

*Grade that they just completed

IT IS NECESSARY FOR THE DAILY SESSIONS TO BEGIN PROMPTLY AT 9 A.M.

The Theme this year is Camp Firelight, trust God to be with us in every situation. Camp Firelight Verse: Whenever I’m afraid, I put my trust in you (Psalm 56:3). The students will hear timeless Bible stories about trusting God and they will enjoy crafts, music, recreation and tasty treats. Along the way, the campers will hear about our mission project and a call for action!

The 6th – 12th grade students are welcome to come and be assistants and aides!
Parent/ Guardian Name*

First NameLast Name
Parent Cell Number*
Please enter a valid phone number.
Parent E-Mail*
example@example.com
Parent Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Child's Name

First NameLast Name
Grade Completed This Year
Child's Date of Birth

MonthDayYear
Date
Child's e-mail
example@example.com
Child's Phone Number *(optional)
Please enter a valid phone number.
PERMISSION FOR EMERGENCY CARE

THE CHURCH HAS MY PERMISSION TO CALL ANOTHER PHYSICIAN IN AN EMERGENCY WHEN FAMILY PHYSICIAN OR I CANNOT BE CONTACTED
Name of Family Physician
Physician Telephone
Is your child allergic to medication?
If yes please list which medications:
Any other allergies: food allergies, bee stings, etc?
Under physician's care?
Under medication now?

Consent to Use Photographs of Minors in Official Church. Publications of Pohick Church

For the purpose of promoting its ministries, Pohick Church will often take photographs of children and staff, or photographs in which children may be involved with others. In order to understand the wishes of parents and/or guardians with respect to the use of these photographs in official publications, this form must be completed and returned with your child's registration information.

For clarity, the term "Pohick Church" as used herein refers to Pohick Church staff and volunteers; "photograph(s)" to both still photographs and videotape footage; "child" to a child who is a minor; and "official publications" to Pohick Church-sanctioned print publications, online publications, presentations, websites, and social media.
*************************************************************************
I understand that photographs of my child may be used in official publications. I also understand that no royalty, fee or alter compensation shall become payable to me by reason of such use. I understand that no other personal identification of my child such as name, age, or grade, will be disclosed.
Consent

For official publications, I consent for Pohick Church to use photographs of my child taking part in church-sponsored activities and/or learning experiences.For official publications, I DO NOT consent for Pohick Church to use photographs of my child taking part in church-sponsored activities and/or learning experiences.
Should be Empty:

2025VBS Youth Volunteer Form

Consent to Use Photographs of Minors in Official Church. Publications of Pohick Church