Sampson's Mills Family Update Form

EPIC

Volunteer Registration
Name*

First NameLast Name
Cell Number*
This will be used for text messages and phone calls.
E-mail*
Date of Birth*

MonthDayYear
EPIC and Sampson's Mills Presbyterian Church have my permission to use any group photos I appear in for print publications, websites, and social media to promote their ministries.
Media Release*

Yes, my permission is granted.No, I do not grant permission.
Emergency Contact Information
Emergency Contact 1*
Name
Emergency Contact 1 Phone Number *

Area CodePhone Number
Emergency Contact 2*
Name
Emergency Contact 2 Phone Number *

Area CodePhone Number
Clearances

All volunteers age 18 and older are required to hold appropriate clearances.
I hold current clearances.*

YESNO
REQUIRED CLEARANCES

Please email jo@sampsonsmills.org for assistance in obtaining the correct clearances.
If your clearances are not already on file with Sampson's Mills Presbyterian Church, you will be contacted by a director to submit copies of your clearances.
Thank you for sharing your time and talent with us this year!

Just click Submit Button Below.
Should be Empty:

EPIC