St. John Vianney Church
CYBL Registration
Volunteer Information

 First Name:                               
Last Name:        
Nick Name:   
Address 1:        
Address 2:    
City:       
State:        
Zip Code:             
Birthdate
mm/dd/yyyy
            
Sex     
Home Phone:
   (10 numeric digits)
            
Cell Phone:        
SJV Parishoner     
 E-mail Primary:                 
 Re-enter Email Primary:                
 
Email Secondary        
Volunteer For:       
Shirt Size:    
        I have previously completed ADW Child Protection registration (Volunteer Application, Attended Class, and Background Check) 
Requests:   

Assumption of Risk
By executing this registration form the named participant represents and warrants that they are unaware of any physical or mental impediment that would or could cause injury or harm to the participant or to others by the said participant’s participation in the activities of the St. John Vianney Family Life Center. Due to the strenuous nature of some activities, the participant is urged to consult a physician concerning their fitness to engage in activities prior to executing this registration. Since all activities present certain inherent and/or inadvertent risks and hazards, know and acknowledge by the undersigned, by their execution hereof, assume all liability incident to the said participation, except that liability, which is imposed by law on the Catholic Archdiocese of Washington, their employees, agents or volunteers.


Electronic Signature (Full Name)            

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