Lihue Missionary Church - Volunteer Application for Children/Youth/Able

Personal Information

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Birthdate

In which children/youth/special needs program(s) do you want to become involved?

Sunday School Teacher

Nursery Worker

Kids Special Events

Youth

Able Special Needs Ministry

What skills would you bring to the program(s)?

Experience

What other children/youth/special needs work experience do you have?

Background Information

Have you at any time ever been convicted of, or pleaded guilty or no contest to, any crime?

Yes

No

If yes, please explain in detail:

Have you at any time ever participated in, or been accused, convicted, or pleaded guilty or no contest to abuse or sexual misconduct?

Yes

No

If yes, please explain in detail:

Are you aware of having any traits or tendencies that could pose any threat to children, youth, or others?

Yes

No

If yes, please explain in detail:

Are you aware of any reason why you should not work with children, youth, or others?

Yes

No

If yes, please explain in detail:

Children/Youth/Special Needs Work Verification Release

I,

Applicant's Name

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recognize that Lihue Missionary Church is relying on the accuracy of the information I provide on this application form.

Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on this application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release Lihue Missionary Church and any such person or entity listed on this application form from liability involving the communication of information relating to my background or qualifications.

I have carefully read the policies and procedures of Lihue Missionary Church, and I agree to abide by them and to protect the health and safety of the children, youth, or adults with special needs assigned to my care or supervision at all times.

Signature

Date Input

Church Activity

What church or churches have you attended in the past 5 years?

Pastor Name(s):

Years attended:

References

Supply at least two independent references--not relatives. Past ministry leaders or former employers preferred:

Reference 1 Name

Relationship

Address

Phone Number

Reference 2 Name

Relationship

Address

Phone Number

FOR MINOR APPLICANTS ONLY--Parental Affirmation and Consent

I,

Parent/Guardian Name

affirm that I am the parent/legal guardian of the applicant.

I recognize that Lihue Missionary Church is relying on the accuracy of the information provided. To the best of my knowledge, I affirm and attest that the information provided is true and correct.

I further affirm that I am aware of no traits or tendencies of

Applicant Name:

that could pose any threat to children, youth, or others.

Signature

Date

Children/Youth/Special Needs Ministry Volunteer Application

About

Service Time

Contact Info

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