Children’s Hunger Fund Volunteer Day SATURDAY APRIL 20TH

Children’s Hunger Fund
Volunteer Day
SATURDAY APRIL 20TH
7:30AM – 2PM
One of our goals for Student Ministries is to find ways to share the love of God with others as a youth group.
We have a good relationship with Children’s Hunger Fund – a ministry that uses volunteers through church
networks to supply Food Paks to families in need along with the gospel. On April 20, we get to serve by being
a part of the workforce that assembles Food Paks at the CHF warehouse. Closed-toe shoes required! This is
always a good time and we are able to accomplish a lot in just a few hours! Please join us for this volunteer
day and bring money for a fast food lunch after we complete our work. Space is limited – sign up now!
Sign Up Deadline = Sun. April 14
Questions? Contact Ryan Rumbley: ryan.rumbley@wefc.org or 630-668-6490
Register Me For The CHF Volunteer Day!
□ I have a WEFC Release Form on file
with WEFC
OR
Name: _______________________________
□ I am turning in a WEFC Release Form
Home Phone: _________________________
□ I have included a completed Children’s
with this registration
Hunger Fund Volunteer Form
Email: ________________________________
Registration Deadline = Sun. April 14
Note: Incomplete or late registrations will NOT hold a spot for you on this event. In order for you to be registered,
we must receive all paperwork and fees by the due date. Registration materials can be securely placed in the
Purple Drop Boxes located in our youth rooms OR mailed to:
Wheaton Evangelical Free Church  Attn: Ryan Rumbley  520 E Roosevelt Road  Wheaton, IL 60187
child name
child name
child name
child name
home
mobile
home
group name, if applicable
his phone
her phone
his email
her email
street
city
female
child name (under 18)
business
child name (under 18)
male
(spouse, if applicable)
mobile
female
name (18 & over)
business
please
print
male
VOLUNTEER SIGN IN
apt #
state
zip
2013 VOLUNTEER DATES
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month day
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HOLD HARMLESS AND RELEASE AGREEMENT FOR VOLUNTEERS
I, ____________________________________________________________, hereby assume responsibility for myself and for the actions of any minor
children in my care while volunteering for Children’s Hunger Fund. I will hold harmless the Children’s Hunger Fund organization,
members of Children’s Hunger Fund, property owner, food manufactures, donors and their employees, from any liability regarding
any accidents or injuries to me, my property, or minors in my care, while engaged in volunteer work. I will also be responsible for,
and assume liability for, any damage that I, or any minor in my care, may cause to property, equipment, or persons, while engaged in
volunteer work. I hereby consent that all photographs and videotapes of me and/or recordings made of my voice for Children’s
Hunger Fund, and its respective vendors, will become a part of said production and as such the sole property of Children’s Hunger
Fund a non-profit 501(c)3 organization. This constitutes a complete release to Children’s Hunger Fund of all claims, whether legal or
equitable. I hereby consent to and approve the foregoing authorization and indemnify Children’s Hunger Fund against any litigation
at any time brought by said undersigned in respect to said authorization only. I have not received any compensation for this project
and am volunteering my time and talents to this project at no cost to Children’s Hunger Fund.
My signature below is an acknowledgement that I have read, understand, and accept the conditions of this hold harmless and release agreement.
X
check
one
YES! I want to hear more about Children’s Hunger Fund. Please add me to your mailing list.
(Don’t worry, we won’t spam you.)
I’d rather not. Thanks though!
Print Student Last Name _______________________
Print Student First Name _______________________
Date _______________________
Parental Consent / Medical Treatment / Release Form 2012-2013
(Valid September 1, 2012 - August 31, 2013)
Wheaton Evangelical Free Church - Student Ministries Department - Pastor of Student Ministries: Ryan Rumbley
I, the undersigned parent or guardian of
_______
, a minor, do hereby authorize adult workers with the youth of the above
named church to consent to any examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under supervision of
any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is
rendered at the office of said physician or at said hospital.
Further, as parent or guardian of the minor named above, I do hereby expressly consent that the minor named above may receive emergency medical treatment from
any physician, hospital, or other medical center without the necessity of first notifying me, and do further agree to hold blameless any physician, hospital or other
medical center for rendering such services. I agree to hold Wheaton Evangelical Free Church and its representatives harmless of any claims, demands or suits for
damages arising from the authorization and provision of any medical treatment for the minor named above. I release Wheaton Evangelical Free Church and its
representatives from any liability due to accident or injury incurred by the minor named above.
In the event that reasonable attempts to contact me at the phone numbers listed below, have been unsuccessful, I hereby give my consent for the administration of
any treatment deemed necessary for the minor named above by the physician listed below under doctor information.
I agree to cover all costs if the minor named above needs to be sent home from any event sponsored by Wheaton Evangelical Free Church for any medical or
disciplinary reason. I consent to the minor named above traveling in any type of transportation provided by Wheaton Evangelical Free Church and its representatives.
I consent to the limited, internal use of images and videos of the minor for use by Wheaton Evangelical Free Church including its web-site, related online publications
and printed material. I also reserve the right to request the removal of any image or video I deem unsuitable for publication.
Basic Family Information
Name(s) of Parent(s) or Guardian(s) ____________________________________
Mailing Address _____________________________________________
____________________________________
Physical Address (if different)
City _____________________ State ________ Zip _______________
Home Phone ___________________ Best Phone _________________
Parent OR Guardian Cell Phones / Email
1.
Name _______________________ Cell # ________________________ Email _______________________________________
2.
Name _______________________ Cell # ________________________ Email _______________________________________
Other Emergency Contacts You Want On File
1.
Name _______________________ Relationship ________________________ Best Phone _________________________
2.
Name _______________________ Relationship ________________________ Best Phone _________________________
Doctor Information
Doctor’s Name _______________________ Doctor’s Phone _________________________
Name of Practice_________________________________________
Insurance Information
Insurance Company ____________________________________________
Group # ____________________ Policy # ____________________ Name of Policy Participant ____________________
Allergies / Medical Information / Medications
Please list allergies, medical situations or medication we need to be aware of:
___________________________________________________________________________________________________________
Common Medications: Is it permissible for your child to take the following, if needed?
_____Aspirin _____Tylenol _____Ibuprofen _____Motion Sickness Medication _____Antacid
Signature of Parent or Guardian ______________________________________ Date _______________
Name of Parent or Guardian (print) ______________________________________
My signature confirms that I have properly completed this form as the legal parent or guardian of the minor named above.
Wheaton Evangelical Free Church, 520 E. Roosevelt Rd., Wheaton, IL 60187