Minor Volunteer Church Leader Application

Name

Phone

Address

Date of birth

Previous work/volunteer experience:

Position you are applying for:

Are you a member of Georgetown CRC?

Yes No

If yes, for how long?

NOTE: Georgetown CRC participates with the Michigan State Police ICHAT system. Your signature on this application authorizes us to do a criminal background check through ICHAT

Have you ever been charged, convicted of, or pled guilty to a crime, either a misdemeanor or a felony?

Yes No

If yes, please explain fully.

Have you ever resigned or been removed from a volunteer position due to an allegation of misconduct?

Yes No

If yes, please explain fully. Please include the date(s) and organization(s) involved.

Please describe your relationship with Jesus Christ and what you hope to accomplish with your involvement here at Georgetown.

I understand that my name and information will be submitted to the administrative staff of Georgetown Church for the purpose of affirming my character and fitness for children and youth ministry. I agree to serve spiritually, with integrity, and will participate in training and discipline to enhance ministry to children and youth. If I am dismissed or removed as a volunteer or employee of this church following an allegation of child abuse or sexual misconduct, I release Georgetown Church from any liability that may arise if the church discloses any such information to another church if it submits a valid request for a reference.

Electronic Signature

By entering my name in the box above, I am providing my digital signature on this form.

Date:

For parent:

I have read the application and give permission for my child to participate as a volunteer. I also authorize Georgetown CRC to conduct a background check through ICHAT.

Name:

By entering my name in the box above, I am providing my digital signature on this form.

Your status as a volunteer will be reviewed every three years. Please advise us if any of the above listed information changes in the future.

Description

Please fill out this form and click submit.

Minor Volunteer Church Leader Application

Description

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