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Volunteer Registration

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Lutheran Church of the Good Shepherd

Location

21100 Victor St.

Torrance, CA 90503

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Contact Kristen Anwandter:

310-542-1649

kristena@lcgs.net

Tell us about yourself:

What positions are you interested in?

At least one choice is required.

Mandatory Volunteer Training: Sunday, July 26th, 11:45 a.m.

If you have a friend you would like to partner with to lead a group, please indicate that in the comment section.

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Phone

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Text Message Phone

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Shirt Size

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Allergies

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Medical Concerns

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Availability

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Date Of Birth

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Gender

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Emergency Contact: Name & Phone #

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Photo Release: Clicking this box indicates my consent to the use of my (if over 18) or my child's image, name, quotation, etc. in all forms for the instructional, advertising, or promotional purposes of LCGS and I waive any right to inspect or approve the finished version.

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Lutheran Church of the Good Shepherd Parent Authorization & Release For Emergency Medical Treatment: The undersigned (electronic signature) does hereby give permission for my child (under 18) named above to attend and participate in activities sponsored by the Lutheran Church of the Good Shepherd, Torrance, CA, and further authorizes, as parents (or guardians) the Pastor(s) and/or the adult advisors to act as patrons for the undersigned to consent to any X-Ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care upon the advice of a physician and surgeon licensed under the provisions of the Medicine Practice Act, or to administer such medical first-aid or assistance as might be required for the immediate care of our child in the event such help of any emergency nature becomes necessary and we cannot be reached. In no event will the Lutheran Church of the Good Shepherd, its pastors, advisors, or representatives be held liable for any first aid or surgical treatment or procedures performed pursuant to this authorization. The undersigned shall be liable and immediately pay all costs and expenses incurred in connection with such medical services rendered to the aforenamed child pursuant to this authorization. The undersigned, for themselves or any representatives, fully and forever release and discharge the driver of the vehicle in which the aforenamed child may be riding while engaged in activities sponsored by the Lutheran Church of the Good Shepherd, from any and all claims, demands, actions, causes of action, suits and liabilities of every kind and nature, and do hereby agree to be solely responsible and liable for the aforenamed child. I acknowledge that typing my name below will serve as an electronic signature, and I certify that I am the parent or guardian of the aforementioned child or I myself am 18 or over.

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Family Physician Name & Phone (write NA if over 18)

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Date of last tetanus shot (write NA if over 18)

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Is your child taking any medications? If so, please explain. (write NA if over 18)

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Name of Insured Parent and Health Insurance Company (write NA if over 18)

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Policy Number (write NA if over 18)

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Insured Parent's Employer (write NA if over 18)

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Employer's Address (write NA if over 18)

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Comments

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