"*" indicates required fields Are you a registered member of Saint George?* Yes No To become a Summer Bible School volunteer or counselor, you must be a member of Saint George. Please complete the Online Membership Form. Counselor/Volunteer InformationName* First Baptismal Last I am a* Counselor Volunteer T-Shirt Size*SELECT ONESmall (S)Medium (M)Large (L)Extra Large (XL)Birth Date* MM slash DD slash YYYY Cell Phone*Email* Allergies/Food Allergies/Conditions/Medications: Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact* First Last Relation Emergency Contact Cell #*Consent and Liability Form and Media Release*I give consent for my participation and/or my participation in the Summer Bible School (SBS) at Saint George Antiochian Orthodox Church, Cicero, IL. I hereby absolve Saint George Antiochian Orthodox Church of Cicero, IL, the Antiochian Archdiocese, affiliate organizations, employees and representatives, of any liability in the event of accident or injury during my participation and/or my child’s participation in the Summer Bible School to be held at Saint George Antiochian Orthodox Church, 1220 South 60th Court, Cicero, IL, 60804, and during corresponding field trips (if any). In addition, I understand I must notify the SBS Staff of any medical history which may cause any harm during my participation and/or my child’s participation in the program. I, also, grant permission for the appropriate use of any photographs, audio recordings, video images, or any other visual or audio reproduction that may be taken of myself and/or my child during SBS to be used in a video, website, social media, for promotional purposes of the program, or shown as Saint George Church sees fit. Furthermore, I understand only proper conduct and behavior befitting the Church will be allowed and disrespectful behavior may result in the dismissal of any person causing misconduct at the cost and responsibility of the said person. I agreeNameThis field is for validation purposes and should be left unchanged.