7/31/2019 SNBC SHRMP Volunteer Application 2012

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South Norfolk Baptist Church Volunteer Application

Sex M F

Name Date of Birth (Month, Day, Year) Age

([ ]) ([ ])

Home Phone Work Phone Parents/Guardians Name If Under 18

Address City, ST ZIP Code

Email Address

Alternative Emergency Contacts

Primary Emergency Contact Relationship Secondary Emergency Contact Relationship

([ ]) ([ ]) ([ ]) ([ ])

Home Phone Work Phone Home Phone Work Phone

Address Address

City, ST ZIP Code City, ST ZIP Code

Medical Information

Primary Physicians Name Phone Number

Insurance Company Policy/ID Number

Group Number (If Applicable) Policy Holders Name

Allergies to food or medicine/Special Health Considerations (Please use a separate sheet if necessary)

I authorize all medical or surgical treatment including X-ray, laboratory, anesthesia, and/or other medical and/or hospital procedures as maybe performed or prescribed by an attending physician and/or paramedics for myself or the child named above and waive my right to informedconsent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency or in thecase of my own incapacity.

Volunteers Signature or Parents/Guardians Signature if under 18 Date

I release South Norfolk Baptist Church and their representatives from liability in case of accident during activities while attending mission tripsrelated to South Norfolk Baptist Church, whether on or off location, as long as normal safety procedures have been taken.

Volunteers Signature or Parents/Guardians Signature if under 18 Date

I hereby authorize South Norfolk Baptist Church to publish and/or display any photos, audio and/or video of myself or my child named above foruse in future publications such as newsletters, brochures or multimedia presentations as well as archiving of photos/videos for future use.

Volunteers Signature or Parents/Guardians Signature if under 18 Date

I hereby authorize South Norfolk Baptist Church to do criminal and civil background checks. I also hereby authorize South Norfolk BaptistChurch to and obtain (if applicable) a DMV and vehicle driving record for Insurance Purposes. I understand that all record reviews may berepeated during the tenure of my volunteering. If you intend on driving church vehicles or carrying volunteers in your personal vehicle,pease attach a current copy of your Drivers License and Insurance Card for verification.Volunteers Signature or Parents/Guardians Signature if under 18 Date

7/31/2019 SNBC SHRMP Volunteer Application 2012

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South Norfolk Baptist Church Volunteer Application Continued

Have you volunteered for SNBC before? Y N

If so, how many years and in what capacity?

In what area(s) would you feel comfortable volunteering? Please check all that apply,

Crew leader Bible story Snack Recreation Registration Crafts Chadder Worship Site Leader

Have you decided to follow Jesus and trust Him as your Savior? Y N

If yes, briefly describe your experience.

Are you a SNBC church member? Y N

If not, what church do you attend?

Please check the times you are available to serve.

Afternoon Evening Both

South Hampton Roads Mission Project T-Shirt Order

Each team member will need a t-shirt in order to participate. Please check the size you would like to order and make checks payableto South Norfolk Baptist Church. The prices below are for one t-shirt.

For all participants paying to stay at the church during the week your t-shirt is included in the price, but we need yourshirt size. Please indicate your shirt size below.

Youth Small $7 Youth Medium $7 Youth Large $7 Youth XL $7

Adult Small $7 Adult Medium $7 Adult Large $7 Adult XL $7 2XL $9 3XL $9 4XL $10 5XL $10

During the South Hampton Roads Mission Project what meals do you anticipate being present for?

Please check all that apply.

Breakfast Lunch Dinner

Please email the completed form to office@southnorfolkbaptist.org