Summer Stretch Adult Participation Form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Days I will Volunteer REQUIRED EVERY DAY! What an amazing week! Monday AM Monday PM (Grand Slam) Tuesday AM Tuesday PM (Bunker Beach) Wednesday AM Wednesday PM (Elm Creek) Thursday ALL DAY (Valley Fair) Friday AM Please fill out this field.

Phone Number REQUIRED

Please fill out this field. Please enter a phone number.

If you are volunteering to help with the mornings, are you willing to drive students to the project sites? Yes No

By being willing to volunteer to serve and drive kids to the project sites, you understand that you will need to have your Virtus Training updated AND complete the Volunteer Driver Training (short online videos). I understand

If yes, how many passengers can your car take (not including driver)? Please enter valid data.

RELEASE OF LIABILITY

I, First and Last Name stated previously, agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless, and defend St. Vincent de Paul Catholic Church, the Archdiocese of Saint Paul and Minneapolis, its officers, directors, agents, employees and representatives (“Releasees”) associated with the Activity from any and all liability claims, injury, loss and damage arising from or in connection with my participation in the Activity.

Further, I AGREE to hold Releasees harmless and indemnify Releasees for any claim or cause of action whatsoever, including but not limited to all claims relating to communicable disease, arising out of the above Activity which takes place during the above identified dates that is brought against Releasees by myself or my family members, heirs, assigns, executors, and
personal representatives.

I UNDERSTAND that participation in the described activity involves danger and risk of injury. The inherent danger is understood and voluntarily assumed.

Medical Release

EMERGENCY MEDICAL TREATMENT: If I should require medical treatment and I am not able to communicate my desires to attending physicians or other medical personnel, I give permission for the necessary emergency treatment to be administered. Please advise the doctors that I have the following allergies and/or other health conditions:

Health Conditions important to know in case of emergency: Please enter valid data.

Emergency Contact First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Relationship to me REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.