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: [email protected] 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 / / / / / / / / / / month day / / / / / / / / / / 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