SUMC Community Vacation Bible School 2026: Adult Volunteers Form

Full Name*

First NameLast Name

Email*

example@example.com

Birthday *

Date

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Relationship: *

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship:

Please provide any information you feel the volunteers may need to maximize your safety and well-being. In case of emergency, this health information may be the only source of accurate and important information. This information is confidential.*

Do you have allergies? ((You will be able to enjoy a healthy snack each night and we will go outside. The list of nightly snacks is available upon request.)*

YesNo

If yes, do you carry an epi-pen?

YesNo

Please list allergies, if yes above.

Do you have asthma?*

YesNo

If yes, do you carry an inhaler?

YesNo

I understand that if a serious illness/injury develops, medical or hospital care will be sought. I further understand that in case of serious illness/injury, my emergency contact will be notified. However, if it is impossible to contact them, I give my permission for medical treatment, as recommended by an attending physician. I give consent to any licensed physician to administer drugs or medicine, or to perform such medical procedures as that physician determines necessary for the relief of pain and to preserve my life or health. I further authorize SUMC and volunteers to give first aid, CPR, or other treatment by a qualified staff member to me.*

YesNo

I approve the release of the above medical information to the VBS volunteers and any treating physician.*

YesNo

My signature below verifies the above information to be correct to the best of my knowledge.

Signature*

I, *

First NameLast Name

*

Give consentDo not give consent

to be photographed/recorded while participating in Vacation Bible School. I understand that these photographs/videos may be used for illustrative or informational purposes on the organization's website (sewickleyumc.org), Facebook Group (facebook.com/sewickleyumc/), Instagram (instagram.com/sewickleyumc/), or in publications. I understand that my child will not be identified by name. I understand that I can contact Sewickley United Methodist Church at any time if I have any questions.

Signature*

SUMC Community Vacation Bible School 2026: Adult Volunteers Form

Information

Primary Emergency Contact

Secondary Emergency Contact

Health Information

Photo Consent

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