Smith Valley Baptist Church
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Volunteer Last Name:
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Gender:
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Address1:
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Email:
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Re-Enter Your Email:
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Home Phone Number:
(xxx-xxx-xxxx)
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Cell Phone Number:
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Other Phone Number:
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Emergency Contact First Name:
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Emergency Phone1:
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Emergency Phone2:
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Home Church (if applicable):
Allergies:
Medical Issues or Special Needs:
Medical Release:
I give my permission for the VBS staff to administer basic first aid to me in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.
Please read the statement above and authorize before continuing.
Photo Release:
I hereby grant the above named church my permission to copyright and use photographs/videos taken at VBS of me in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Age:
11
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Adult
General Information: