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Adult VBS Volunteer Form

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  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 Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  T-Shirt Size REQUIRED Please fill out this field.
  
  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.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Are you Safe Environment cleared? REQUIRED Yes No Please fill out this field.
  
  Do you have a badge? REQUIRED Yes No Please fill out this field.
  
  Are you a parishioner at St. Jude? REQUIRED Yes No Please fill out this field.
  
  During VBS, I would like to help with the following areas (Select 3 Requests):
  
  First Choice REQUIRED Please fill out this field.
  
  Second Choice REQUIRED Please fill out this field.
  
  Third Choice REQUIRED Please fill out this field.
  
  Please fill out the following information concerning your health insurance and health concerns.
  
  Medical Insurer REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Policy # REQUIRED Please fill out this field. Please enter valid data.
  
  Group # REQUIRED Please fill out this field. Please enter valid data.
  
  Medical Conditions: REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies REQUIRED Please fill out this field. Please enter valid data.
  
  Current Medications REQUIRED Please fill out this field. Please enter valid data.
  
  Drug Allergies REQUIRED Please fill out this field. Please enter valid data.
  
  Asthma REQUIRED Yes No 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.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. 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 of 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.
  
  I Agree Please select this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
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St. Jude Catholic Parish

Allen, TX

Adult VBS Volunteer Form