LITTLE LAMB ROUND-UP VBS YOUTH (12-17 YRS) VOLUNTEER FORM
Please fill out this form and click submit.
Main Contact/Contacto Primario
*
Father's Name- First & Last-Nombre de Padre
*
Mother's Name- First & Last- Nombre de Madre
*
Address-Direccion
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Family Email-Correo Electronico de Familia
*
This address will receive a confirmation email
Father's Phone-Telefono de Padre
*
Mother's Phone-Telefono de Madre
*
Emergency Contact name-Contacto de Emergencia
*
Emergency Contact phone number-Numero de Contacto de Emergencia
*
Emergency Contact Relationship-Relacion de Contacto de emergencia
*
Youth Volunteer -Voluntario Joven
First & Last Name-Nombre
*
Youth gender-Joven género
*
Please select all that apply.
male
female
ALL YOUTH VOLUNTEERS MUST BE 17 OR YOUNGER
Youth birthday-Joven cumpleaños
*
Grade in 2023-2024 CHOOSE ONE GRADE ONLY- grado en 2021-2022 ELIJA SOLO UN GRADO
*
Please select one option.
6th
7th
8th
9th
10th
11th
12th
Parent Consent-Consentimiento de los padres
CONSENT & LIABILITY WAIVER I as the parent and or guardian grant permission via this electronic/digital form for my child(ren) listed on this electronic form to participate in VBS 2024 Youth Faith Formation Program to be held from July 8-11, 2024 at St. Luke the Evangelist Catholic Church 11011 Hall Rd. Hou, TX 77089 In consideration of my child’s participation in this event, I agree on behalf of myself, my child named herein, and our heirs, successors, and assigns to indemnify, hold harmless and defend the Archdiocese of Galveston-Houston, the sponsoring parish, its pastor, youth ministry leader, other agents, employees or other representatives associated with the event from any and all injuries, losses or claims arising out of my child’s participation in the event. In signing this form I certify that all information contained herein is true and accurate to the best of my knowledge. I acknowledge that by checking form I am granting electronic consent. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ CONSENTIMIENTO Y RENUNCIA DE RESPONSABILIDAD Yo, como padre o tutor, otorgo permiso a través de este formulario electrónico / digital para que mi (s) hijo (s) enumerados en este formulario electrónico participen en (evento) Programa de formación en la fe para jóvenes que se llevará a cabo desde 8 -11 de Julio 2024 Iglesia católica St. Luke the Evangelist 11011 Hall Rd. Hou, TX 77089 En consideración a la participación de mi hijo en este evento, acepto, en mi nombre, el de mi hijo aquí mencionado y nuestros herederos, sucesores y cesionarios, indemnizar, eximir de responsabilidad y defender a la Arquidiócesis de Galveston-Houston, el patrocinador parroquia, su párroco, líder del ministerio juvenil, otros agentes, empleados u otros representantes asociados con el evento de todas y cada una de las lesiones, pérdidas o reclamos que surjan de la participación de mi hijo en el evento. Al firmar este formulario, certifico que toda la información contenida en este documento es verdadera y precisa a mi leal saber y entender. Reconozco que al marcar el formulario estoy otorgando consentimiento electrónico.
*
Please select all that apply.
I agree/estoy de acuerdo
Medical Consent: In the event of an emergency, I hereby give permission to the staff of St. Luke the Evangelist Catholic Church to seek emergency medical transport and/or treatment for my child(ren) named above. I will be responsible for all costs incurred. I wish to be advised before further care is given by the hospital or doctor. ---- Consentimiento médico: En caso de una emergencia, por la presente doy permiso al personal de la Iglesia Católica St. Luke the Evangelist para buscar transporte médico de emergencia y / o tratamiento para mi (s) hijo (s) mencionado anteriormente. Seré responsable de todos los costos incurridos. Deseo que me avisen antes de que el hospital o el médico brinden más atención.
*
Please select all that apply.
I consent/yo consiento
The virus that causes COVID-19 can infect people of all ages. Persons of ALL AGES can be infected with COVID-19 and some will develop a severe illness. Even a child with a mild or asymptomatic case of COVID-19 can spread the infection to others, including those who may be far more vulnerable. While precautions will be taken at the St. Luke VBS , some of the protective measures that we can expect from adults are, for a variety of reasons, simply not practicable for children. COVID-19 is easily spread from person to person by coughing, sneezing, speaking, and even breathing. A group of young people may not maintain social distancing and other safeguards. Parents and Guardians should monitor the health of their child and NOT send their child to the St. Luke VBS if the child is displaying any symptom of COVID-19. I grant permission for my child to participate in the St. Luke VBS. This will take place under the guidance and direction of Office of Youth Faith Formation PK-12 of St. Luke the Evangelist Catholic Church Archdiocese of Galveston-Houston) and the staff and volunteers of the St. Luke VBS As parent and/or legal guardian of the child I acknowledge that I am aware of the COVID-19 virus and I acknowledge that my child may be exposed to the virus while attending the St. Luke VBS. I agree I will not allow my child to attend the St. Luke VBS, if my child displays any symptoms of COVID-19 or has been exposed to anyone with COVID-19. I will notify St. Luke staff or VBS volunteer immediately if my child is exposed or develops symptoms. I agree to comply with rules and directives of the St. Luke VBS. I understand that the St. Luke VBS will include group activities and meals served in a group setting. IN CONSIDERATION OF MY CHILD BEING ABLE TO ATTEND VBS I AGREE ON BEHALF OF MYSELF, MY CHILD NAMED HEREIN, OR OUR HEIRS, SUCCESSORS, AND ASSIGNS, TO HOLD HARMLESS, RELEASE AND DEFEND THE ARCHDIOCESE OF GALVESTON-HOUSTON, THE SPONSORING PARISH/SCHOOL, AND THEIR EMPLOYEES, OFFICERS, VOLUNTEERS, AGENTS, OR REPRESENTATIVES FROM ANY CLAIMS, DAMAGES OR LIABILITIES ARISING FROM COVID19 IN CONNECTION WITH MY CHILD’S ATTENDANCE AT THE VBS, INCLUDING ANY COVID-19RELATED ILLNESS OR INJURY OR COSTS OF MEDICAL TREATMENT FOR COVID-19. ___________________________ l virus que causa COVID-19 puede infectar a personas de todas las edades. Las personas de TODAS LAS EDADES pueden infectarse con COVID-19 y algunas desarrollarán una enfermedad grave. Incluso un niño con un caso leve o asintomático de COVID-19 puede transmitir la infección a otros, incluidos aquellos que pueden ser mucho más vulnerables. Si bien se tomarán precauciones en St. Luke VBS, algunas de las medidas de protección que podemos esperar de los adultos son, por una variedad de razones, simplemente no practicables para los niños. COVID-19 se transmite fácilmente de persona a persona al toser, estornudar, hablar e incluso respirar. Es posible que un grupo de jóvenes no mantenga el distanciamiento social y otras salvaguardias. Los padres y tutores deben monitorear la salud de su hijo y NO mandar a su hijo al St. Luke VBS si el niño muestra algún síntoma de COVID-19. Como padre o tutor legal del niño, reconozco que estoy al tanto del virus COVID-19 y reconozco que mi hijo puede estar expuesto al virus mientras asiste a St. Luke VBS. Acepto que no permitiré mi niño para asistir a St. Luke VBS si mi hijo muestra algún síntoma de COVID-19 o ha estado expuesto a alguien con COVID-19. Notificaré al personal de St. Luke o al voluntario de VBS de inmediato si mi hijo está expuesto o desarrolla síntomas. Estoy de acuerdo en cumplir con las reglas y directivas de St. Luke VBS. Entiendo que St. Luke VBS incluirá actividades grupales y comidas servidas en un ambiente grupal.
*
Please select all that apply.
I consent/ estoy de acuerdo
VIDEO/PHOTOGRAPHY CONSENT As parent/guardian, I understand that promotional pictures and videos (individual and group) will be taken during this event. I Give permission for my son’s/daughter’s pictures to be used for promotional materials (newsletter, web page, calendars, power point, video, etc.) in highlighting the event.------CONSENTIMIENTO DE VIDEO / FOTOGRAFÍA Como padre / tutor, entiendo que se tomarán fotos y videos promocionales (individuales y grupales) durante este evento. Doy permiso para que las fotografías de mi hijo / hija se utilicen como material promocional (boletín, página web, calendarios, power point, video, etc.) para destacar el evento.
*
Please select one option.
Yes/Si
No
“By registering your child(ren) for faith formation you give permission to the parish to provide its catechists with access to your child(ren) for the purpose of catechesis. Depending on the circumstances and the program, this access may be face-to-face in a parish facility, or may be on a virtual platform approved and overseen by the parish, or both. All catechists have been cleared by the Archdiocesan Office of Child and Youth Protection to work with minors and have completed all required safe environment training.”
*
Please select all that apply.
I acknowledge/ Yo Reconozco
Youth Volunteer will abide by all behavior standards set form in Volunteer Handbook and will follow all COVID-19 Social Distancing Rules
*
Please select all that apply.
I agree
Youth Electronic Signature- please acknowledge this form by providing an electronic signature: type your legal first and last name.------Firma electrónica: reconozca este formulario proporcionando una firma electrónica: escriba su nombre y apellido legal.
*
Parent/Guardian Electronic Signature- please acknowledge this form by providing an electronic signature: type your legal first and last name.------Firma electrónica: reconozca este formulario proporcionando una firma electrónica: escriba su nombre y apellido legal.
*
Submit
Description
Please fill out this form and click submit.
×
Please Fix the Following
