Returning Adult Volunteer Form

First Name *

Preferred Name *

Last Name *

Email Address *

Mobile Number *

Mailing Address *

Mailing Address Line 2

Mailing City *

Mailing State *

Mailing Zip Code *

T-Shirt Size (unisex) *

Date of Birth *

I want to serve at... (Select all that apply)

VBS! (June 1-5)

Fine Arts Day Camp! (July 13-17)

Been arrested for any reason? *

Yes

No

Please explain in detail: *

Been convicted of or pleaded guilty or no contest to any crime? *

Yes

No

Please explain in detail: *

Engaged in or been accused of any child molestation, exploitation, or abuse? *

Yes

No

Please explain in detail: *

Having any traits or tendencies that could pose a threat to children, youth, or others? *

Yes

No

Please explain in detail: *

Any reason why you should not work with children, youth, or others? *

Yes

No

Please explain in detail: *

I give permission for myself to be photographed or videoed during events and activities either at or sponsored by LFBC. I also grant LFBC permission to publish and/or share my name, picture, portrait, video, and/or photograph in all forms and media and in all manners, for display, publication, advertising, promotions, websites, and any other lawful purposes, taken of children and adults during this event, on LFBC website and/or other LFBC publications/media. I waive any right that I may have to inspect and/or approve the finished product(s) and I release, hold harmless, and covenant not to sue, Lilburn First Baptist Church, its agents, and employees from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to me related to the publication and/or sharing of the name, picture, portrait, video, and/or photograph. *

Yes

No

I hereby consent to my participation in events of scheduled activities either at or sponsored by Lilburn First Baptist Church ("LFBC") and agree to assume all of the risks related to such participation. I understand that participation in athletic activities sponsored by LFBC involves the risk of injury. I authorize a representative of LFBC to contact medical personnel to perform x-rays, tests, or perform or provide other medical treatment deemed necessary or desirable for my car. I give permission for administration of medication, injections, and/or anesthesia and/or surgery if deemed necessary or desirable by medical personnel for my care. I also authorize the release of the above information to assist with their decisions for my care. I release, hold harmless, and covenant not to sue, First Baptist Church of Lilburn, its agents, and employees from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury or associated medical care administered to me or during and/or relating to or arising out of participation in events and activities either at or sponsored by LFBC. *

Yes

No

I recognize that First Baptist Church of Lilburn is relying on the accuracy of the information I provide on the Volunteer Renewal Application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct. *

I voluntarily release the organization and any such person or entity listed on the Volunteer Renewal Application form from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation if such a check is deemed necessary. *

I agree to abide by all policies and procedures of the organization, and to protect the health and safety of the children or youth assigned to my care or supervision at all times. *

Please type your full name below to confirm that the information you agree with the above statements. *

Today's Date *

I'm available to serve the whole week of VBS. *

Yes

No

Tip: (VBS is June 1-5)

Dates Available (VBS is June 1-5)

Tip: If you are not available to serve the whole week, please list the days of the week you are available to serve.

Outside of the week of VBS, I'd like to help by ... (select any that apply)

Praying

Preparing craft materials

Helping with administrative tasks

Helping with creating decorations (painting, cutting, etc.)

Helping with building the stage set

Helping decorate classrooms

Helping with follow up after VBS

Helping with the block party on June 8th

Helping with set up and clean up

Tip: Scroll for more options!

Preference on where to serve (select any that apply)

Tip: Scroll for more options!

Other (please write where you'd like to serve)

Anything else you need to share?

I'm available to serve the whole week of Fine Arts Day Camp. *

Yes

No

Tip: Fine Arts Day Camp is July 13-17

Dates Available (Fine Arts Day Camp is July 13-17)

Outside of the week of Fine Arts Day Camp, I'd like to help by ... (select all that apply)

Praying

Preparing craft materials

Helping with administrative tasks

Helping with the showcase set up on Friday

Helping with set up and/or clean up

Helping with follow up after Fine Arts

Preference on where to serve (select all that apply)

Tip: Scroll for more options!

Anything else you need to share?

Other (please write where you'd like to serve)

Personal Information

Volunteer Renewal Application

Have you at any time ever:

Are you aware of:

Photo Release

Medical Release

Worker Renewal Work Verification and Release for Volunteers (Please read and initial each statement.)

VBS Information

Fine Arts Day Camp Information