Please indicate below if you have an Epi-Pen or Inhaler, and bring these with you to VBS.
Please give the month and year of the volunteer's last TETANUS shot.
Please Write Name of Emergency Contact in box above, and phone number below.
In the event the emergency contact given above cannot be contacted, I hereby give my consent for adult volunteer(s) and/or staff member(s) of Spriggs Road Presbyterian Church to authorize emergency medical treatment for the registrant named in this form. I certify that the facts given above concerning medical conditions/history are true and complete to the best of my knowledge. I, furthermore, understand that I assume any and all financial responsibility for emergency medical treatment should it be needed. This release is valid for and limited to the week of Vacation Bible School, June 26-30, 2023.
At Spriggs Road Presbyterian Church we strive to do all that we do for the glory of Christ and with love for our neighbor. We believe loving our neighbor includes not only how we personally interact with others, but also in doing all that we can to prevent others from harming our neighbors. This is especially true in regard to the safety of those who are not able to protect themselves (Proverbs 31:8-9, Isaiah 1:17). Our denomination’s 42nd General Assembly approved an overture calling for PCA churches to adopt policies and procedures to protect children in our churches (“Protecting Children in the PCA,” Overture 6, 2014). The overture rightly points out that we ought to love our children as Christ loves children, "for to such belongs the kingdom of heaven" (Mark 10:14). As it is our duty in loving the children to also do all we can to protect these little ones from harm, we must do what we can to prevent people who have known sex offense or other criminal histories from working with the children. By checking the "I agree" box above, you, as a volunteer in this VBS program, agree to at all times treat all the children with the same kind of love and gentleness that Christ demonstrated and pledge to keep your conduct with the children on the highest level of propriety without giving even any "appearance of evil" (1 Thessalonians 5:22). You furthermore agree to a background check [if you are 18 years old or older] and understand that checking “I agree” constitutes your prior warning of and your consent to such a background check.
By checking the "I agree" box above, I understand that photographs and/or videos of children and volunteers are often taken during Vacation Bible school. I am aware that photographs or videos may be posted on the church’s website, its Facebook page, in church newsletters, or on the projection screen during Sunday morning announcement time. Since these images are not sold or used in any way for profit, I understand that there is no compensation given to persons photographed. I release, discharge, and agree to hold harmless Spriggs Road Presbyterian Church, its photographers, agents, employees, volunteers, representatives or assigns from any liability for any reason in connection with the capturing and using of such photographs or videos in the manner which is here described.
I understand that participation in VBS sponsored by Spriggs Road Presbyterian Church (hereafter referred to as “the church”), June 26-30, 2023, whether as a volunteer staff member or as a child attendee does present some risk to person and/or property. I understand that this event will entail Bible lessons; participating in games; playing indoors and outside; participating in crafts or games involving water, finger paint, and other non-toxic but possibly messy substances; and having snacks. I understand that all attending are encouraged to take precautions to protect their clothing and personal property. Children are encouraged to wear “play clothes” and to not wear, or to carry with them, unnecessary and expensive clothing, accessories, and/or handheld electronic devices. I certify that I have made the church aware of any limitations in the registrant's ability to participate in these activities as well as any health problems, allergies, and/or food sensitivities. I agree that the registrant will come to VBS equipped with all his/her own necessary adaptive/supportive equipment, medical devices, or medications to include items such as crutches, knee brace, inhaler, glucose meter, or epi-pen (if such items have been prescribed). I agree that the registrant will not come to VBS if he/she is in a contagious state of any communicable condition (for example, pink eye, strep throat, chicken pox, head lice) and I will make every effort to notify the church if he/she contracts such a condition while attending VBS. I understand that, while the church will provide adequate supervision and take necessary safety precautions, accidents do sometimes happen. I, therefore, hereby agree to assume all the risk which may be encountered during VBS, including activities preliminary and subsequent thereto. I do, for myself [and for my child (if registrant is a minor)], heirs, and assigns, hereby irrevocably and unconditionally release, acquit, and forever hold harmless the church, and all its agents, employees and volunteers, from any and all liabilities, actions, causes of actions, claims, expenses, obligations, and damages of any nature whatsoever in connection with participation in the described activity or in any other associated activities including, but not limited to, any illness or injury, as well as, damage to, theft of, or loss of personal property.
