Teen Volunteer

Page 1 of 4

Teen
  1. Teens entering 7th grade - 12th grade this fall - you will need a parent/guardian to complete sections of this registration form.

    Questions can be directed to Jen Lifer, Teen Volunteer Coordinator

    Phone number: (614) 271-1550
    Email: jenborucki@yahoo.com
  2. Personal Information

  3. First Name
    Enter your first name.
  4. Last Name
    Enter your last name
  5. Primary Phone
    Enter your primary phone number
  6. Other Phone
  7. Street Address
    Enter your street address
  8. City
    Enter your city
  9. ZIP
    Enter your ZIP Code
  10. Email
    Enter your email
  11. Grade Entering This Fall
    Please select a grade
  12. T Shirt Size
    Invalid Input
  1. Volunteering Preferences

  2. Days You Can Serve (8:40am-12noon)




    Please make a selection

  3. Request to be placed with. (We will try to accommodate request if possible)



    Please make a selection.
  4. Full name of individual

  5. First Choice Work Preference







    Invalid Input
  6. Second Choice Work Preference







    Invalid Input
  7. Third Choice Work Preference







    Invalid Input
  8. Class Guide Grade Preference







    Invalid Input
  1. The Following Sections Are For A Parent/Guardian to Complete


  2. Parent/Guardian First Name
    Enter your first name.
  3. Parent/Guardian Last Name
    Enter your last name
  4. Street Address
    Enter your street address
  5. City
    Enter your city
  6. ZIP
    Enter your ZIP Code
  7. Parent/Guardian Phone
    Enter your primary phone number
  8. Email
    Enter your email
  9. Emergency Health Information



    Please explain in detail any special needs, food allergies or medical conditions of which we need to be aware. Include symptoms to watch for, actions to be taken, specific instructions for the administration of any needed medications (including epi-pens), and follow-up procedures.

    The text box will expand to accommodate your information.
  10. Invalid Input
  11. Physician's Name
    Please enter doctor's name.
  12. Physician's Phone
    Please enter doctor's phone.
  13. Emergency Release



    Granville Ecumenical VBS has a volunteer nurse each morning to help us provide the safest environment for all participants. Every effort will be made to notify parents of any concerns. However, if there should be a need for medical care and we are not able to reach the parent, and the incident is beyond the scope of our nurse, we want to access the care needed through our Granville Fire Department and Emergency Squad.

    Please complete one of the following.

  14. Invalid Input
  15. Parent/Guardian Signature
    Please sign
  1. Others to notify if we cannot reach a parent

  2. Contact Full Name
    Enter a contact name
  3. Phone
    Enter a contact's phone
  4. Relationship
    Invalid Input
  5. Contact #2 Full Name
    Enter a contact name
  6. Phone
    Enter a contact's phone
  7. Relationship
    Invalid Input
  8. Do you give permission to Granville VBS to photograph your child for use by Granville VBS?

    select one