Harvest Sunday - Non Driver Adult | Maternity of the Blessed Virgin Mary Catholic Church

Harvest Sunday Adult - Non Driver

If you are 18 or older, you need the Protecting God's Children Class and a background check to volunteer with our youth

click here if you have need to register for Protecting God's Children.

Reach out to Amanda Fierce with questions. Thank you! 815-933-8285 x335

: Adult Volunteer Authorization & Registration for Harvest Sunday Non-Driver
Participant's First and Last Name
Which Harvest Sunday route # did you sign up for?
Birthdate mm/dd/yy
Home Address
City
State
Zip Code
email address of participant
Cellphone Number of Participant
Parish (or church name if member of a church)

Emergency name and number


: Medical Insurance Information in case of emergency
Policy in the name of:
Insurance Company
Name of Physician
Physician phone number
Specific medical allergies, dietary restrictions, chronic illness, or conditions: (type none if none apply)
List of any medications currently using (type none if none are taken)

Liability Waiver: By checking this box I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Maternity BVM Parish, Diocese of Joliet, its officers, directors, agents, employees, or representatives associated with parish transportation programs from any and all liability claims, loss or damages arising from or in connection with my participation in parish transportation programs.
Hold Harmless: I am a volunteer at Maternity BVM Parish (the “Parish”). I choose to continue to volunteer with the Parish during the COVID-19 global pandemic. I fully understand the risks associated with the COVID-19 virus. I have read and I fully understand the prescribed CDC guidelines and the Diocese of Joliet’s guidelines related to COVID-19 and agree to follow the same. I agree to protect, defend, hold harmless and fully indemnify the Parish and the Diocese of Joliet for any claim or cause of action whatsoever arising out of my volunteer work during this period of time, including any claim related to COVID-19, whether such claim is brought by me or my family members, and whether such claim arises from the alleged negligence of the Parish, its employees, agents or volunteers.
Medical Authorization: By checking this box I grant permission for the administration of First Aid by the people in charge of this event as their judgement deems advisable, and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature if I am unable to do so. I understand that my emergency contact will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact my emergency contact. In the event that he/she cannot be reached, I hereby give permission to the physicians selected by the adult staff/volunteer to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary.
Code of Conduct: By checking this box I understand that the following Code of Conduct must be followed: Arrive on time. Demonstrate common courtesy and respect at all times. Inappropriate language/behavior will not be tolerated. Socialize in public areas. Dress modestly. Writing on clothing should reflect Christian values. The possession or consumption of any alcoholic beverage and/or possession/use of any illegal drug is not permitted. Smoking or vaping is not allowed. Weapons and/or drug paraphernalia are not allowed. Infraction of any of these rules can mean immediate dismissal with no refund. Participants will be responsible to local authorities as well. I understand and agree to this Code of Behavior. I also understand and agree that at the time of infraction requiring my dismissal, I am responsible for my removal from the premises and any costs involved.
Use of Photographs/Videos for Marketing Purposes Permissions: By checking this box, I grant permission to be photographed or videotaped or the purpose of promotional efforts on the church's social media, website and/or newsletter and bulletin.

: Protecting God's Children Class Certification
Have you taken the Protecting God's Children Class?: Yes, I have taken the class alreadyNo, I have NOT taken it
If you have taken the Protecting God's Children Class already, what parish or school did you take it at?
: If you have not had a background check performed within the past 5 years here at Maternity, you may be asked to complete a new one. We will notify you if that needs to be done.
: Important! Don't forget to click on "Submit" below

Harvest Sunday - Non Driver Adult

Adult Volunteer Authorization & Registration for Harvest Sunday Non-Driver

Medical Insurance Information in case of emergency

Protecting God's Children Class Certification

Important! Don't forget to click on "Submit" below

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