Teen Volunteer Form

Teen's Name

Birth date:

Grade:

Year of Graduation

Will you be receiving credit for your volunteering through school or any other group? Yes No

Parent/Guardian Name

Relationship to applicant

Home Phone

Work Phone

Cell Phone

Address

Place of Employment

EMERGENCY NOTIFICATION AND CONSENT

In the event that my child should require medical attention while on duty as a volunteer, I understand that the Angel Foundation staff will first mke every attempt to contact me and if unable, will do so through emergency numbers listed below.

Emergency Contact Name

Relationship to Teen

Home Phone:

Work Phone:

Consent

In the event that the staff is unable to reach me or the emergency contact person. I hereby authorize and direct any adult activities sponsor or group leader for Angel Foundation to provide reasonable first aid or make other emergency medical decisions as well as transporting my child to a health care facility for treatment. I also authorize the staff to designate a staff member to administer the prescription medication to my child pursuant to the Medication Section below. MEDICAL CONDITIONS/MEDICATION: My child is subject to the following allergies or medical conditions, and I authorize the staff of Angel Foundation to disclose such allergies or medical conditions to a physician in the event my child should require medical care. Please list any medication your child takes and the times that your child must take the medication.

Medication

Parent Signature

Date

Teen Signature

Date2

These items are required.