VBS 2021 ADULT Volunteer Registration
{Use this form to sign up to help with VBS.}
Please sign up 1 volunteer at a time.
All volunteers must complete a background check before working with minors.

June 13-17 2021 // 5:30-8:15 PM
Dinner will be provided all week long for volunteers and their participating families.

Thank you in advance for devoted time, energy, and talents!

Flipside Christian Church
37193 Ave 12 #3h, Madera, CA 93636

Questions? Contact Myranda Roth: myranda@acts176.com

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Name (First & Last): *
Home Address: *
E-mail: *
Phone Number: *
Emergency Contact (Name & Phone Number): *
T-Shirt Size *
Required
I would like to volunteer in (check all that apply): *
Required
Photo Release Agreement
I hereby acknowledge and grant Flipside Christian Church permission to use my or my child's likeness in a photograph, video, or other digital media ("photo") in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of Flipside Church and will not be returned. Hereby irrevocably authorize Flipside Church to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo(s). I hereby hold harmless, release, and forever discharge Flipside Church from all claims, demands, and causes if action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Medical / Liability Release
I do hereby authorize FLIPSIDE CHRISTIAN CHURCH and/or its agents to conduct an independent investigation of my background and release and agree to hold harmless Flipside Christian Church and any related member, employee, sponsor or agent from any liability, injury, damages, loss, accidents, delay, or irregularity related to the listed persons planned participation in FLIPSIDE CHRISTIAN CHURCH. This release covers all rights and actions of every kind, nature, and description, which the listed person ever had, now has, or but for the release, may have.
I understand the following:

If I witness or participate in any misconduct with a minor, I will be reported to the Madera Police Department and will be
refrained from participating in any activities of Flipside Christian Church until the issue is resolved. I will report anything I
understand to be harmful to any child who attends any of the programs of Flipside Christian Church. I commit to abide by
all of the safety procedures required of me as a volunteer that are required of me by Flipside Christian Church.

Before you join us, please confirm that you:
- Do not have a fever, shortness of breath, or a cough
- Have not come in contact with anyone that you know had Covid-19 or Covid-like symptoms in the last 10 days
- Have not had a positive Covid-19 test in the last 10 days or waiting on Covid test results
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