2022-2023 Teen Volunteer RE

Contact Information

Full Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Email REQUIRED Please fill out this field. Please enter an email address.

Home Phone # Please enter valid data.

Cell Phone # REQUIRED Please fill out this field. Please enter valid data.

Teen Email REQUIRED Please fill out this field. Please enter an email address.

Teen Cell # REQUIRED Please fill out this field. Please enter a phone number.

Is it ok to text this person? REQUIRED Yes No Please fill out this field.

School REQUIRED Please fill out this field. Please enter valid data.

Grade REQUIRED Please fill out this field. Please enter valid data.

Have you taken the TEEN Safety Class (One Time Only) REQUIRED Yes No Please fill out this field.

Have you worked in religious education in the past? REQUIRED Yes No Please fill out this field.

If yes, please indicate your assignment(s) and the ages of children with whom you have worked.

The next section is for those who would like to volunteer to assist our RE program.

Volunteer

The next section is relating to emergency contact information for your children, other than the parent of the child.

Medical Information

Medical Insurer REQUIRED Please fill out this field. Please enter valid data.
Policy # REQUIRED Please fill out this field. Please enter valid data.
Group # REQUIRED Please fill out this field. Please enter valid data.
Allergies REQUIRED Please fill out this field. Please enter valid data.
Drug Allergies REQUIRED Please fill out this field. Please enter valid data.
Do you have asthma? REQUIRED Yes No Please fill out this field.
Please list any current medications you take including dosages. REQUIRED Please fill out this field.

Emergency Contact Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Cell Number Maximum 20 characters Please enter a phone number.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Relationship REQUIRED Please fill out this field. Please enter valid data.

Authorization for Emergency Treatment

I, who by law may do so, authorize the administration of emergency medical treatment to he/she who is subject of the form. I understand that all reasonable safety precautions will be taken at all times by St. Jude or its agents liable for any accident, injury or disease incurred by the subject of this form. I understand that, in the event medical intervention is needed, every attempt will be made to contact the person(s) above immediately.

Consent REQUIRED Please fill out this field.

St. Jude Catholic Parish

Allen, TX

2022-2023 Teen Volunteer RE