Lake City CRC Children/Youth Volunteer Application

Personal Information

Name

Home Phone

Mobile

Address

Birthdate:

Gender

Male Female

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

Yes No

Have you ever had children removed from your care due to allegations of chld abuse or neglect?

Yes No

If you answered 'yes' to either of the above questions, please explain in detail.

I Want to Volunteer for: (You may select more than one!)

Volunteer Experience

What skills/talents would you bring to the children/youth programs?

Briefly describe any child/youth volunteer or work experience you have. Include organization names, programs, and dates served.

References

If this is your first time volunteering for the Lake City CRC, please list three references (other than relatives).

Name

Address

Phone

Relationship

Name

Address

Phone

Relationship

Name

Address

Phone

Relationship

Applicant Verification Release

I recognize that the Lake City Christian Reformed Church, to which this application is being submitted, is relying on the accuracy of the information contained herein. Accordingly, I attest and affirm that all of the information that I have provided is absolutely true and correct.

I authorize the Lake City Christian Reformed Church leaders to contact any person or entity listed in this application, and I further authorize any such person or entity to provide the Lake City Christian Reformed Church with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the Lake City Christian Reformed Church and any such person or entity listed herein from liability involving the communication of information relating to my background or qualifications. I further authorize the Lake City Christian Reformed Church leaders to conduct an annual criminal background investigation if such a check is deemed necessary.

I have carefully read the policy and procedures of the Lake City Christian Reformed Church, and I agree to abide by them and to protect the health and safety of the children or youth at all times.

By placing your name in the box below you attest that this is your signature and you are agreeing with not just the above statement but that this entire form is true to the best of your knowledge

By checking this box and entering my name below I am electronically signing this volunteer application and am agreeing to the above paragraphs.

Name

Date

Lake City CRC Children/Youth Volunteer Application

Description

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