2023 VBS Volunteer Registration

Volunteer Information

Volunteer Last Name

First Name*

Last Name*

Parent/Guardian Name (For Teens)

First Name

Last Name

Address

Street 1*

Street 2

City*

State*

Zip*

Daytime Phone

Required* --

E-mail

Required*

(for updates)

EMERGENCY CONTACT

Contact person if parent cannot be reached

Name

First Name*

Last Name*

Relationship

Required*

(Grandparent, Neighbor, Friend, etc.)

Phone

Required* --

(Daytime)

Physician's Name

First Name*

Last Name*

Physician's Phone

Required* --

Medical Information

Allergies, Notes, Etc.	Required*	Please note below any Allergies, Pertinent medical information or notes you wish to include regarding your child(ren).

Volunteer Clearances (Over age 18)

Criminal Background Check
Required*

Dated June 2018 or later*

	Yes
	No

Child Abuse Clearance
Required*

Dated June 2018 or later*

	Yes
	No

Fingerprint Affidavit
Required*

If lived in PA longer than 10 years*

	Yes
	No

Proof of Fingerprinting
Required*

If lived in PA less than 10 years*

	Yes
	No

VIRTUS training certificate
Required*

	Yes
	No

Code of Conduct
Required*

Downloaded from stjc.org VBS page*

	Yes
	No

Student Volunteer Entering 7th Grade and Up

What grade will you be entering Fall 2023

Select from dropdown below *

Must be 7th grade or higher

Youth Code of Conduct

Downloaded from stjc.org VBS page

	Yes
	No

Information regarding clearances

Message	Information regarding necessary clearances and Background Check Application can be found at: http://www.dioceseofscranton.org/about/compliance-office

VOLUNTEER FORMS DUE BY JUNE 1ST - NO EXCEPTIONS !!

I would like to help before VBS Week

I would like to help by

Check all that apply

	Planning and organizing
	Preparing craft materials for daily projects
	Making/painting VBS Scenery
	Setting up for VBS - Gym/Stage,Classrooms, Kitchen, Playground - Friday 6/15 and Saturday 6/16

I would like to help in the following areas

I would like to help in these areas - Please make no more than three (3) choices

VBS T-shirt

If working the VBS week ...

I have my VBS t-shirt from last year:
Required*

	Yes
	No

If no, what size t-shirt do you need?

	Youth L
	Adult S
	Adult M
	Adult L
	Adult XL
	Adult 2XL

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2023 VBS Volunteer Registration

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