Family Ministries Volunteer Application Please indicate which ministry you applying for * Kid City/Nursery Volunteer Youth Group Volunteer Childcare Provider Name * First Name Last Name Email * Phone (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Reference Please list the name of one HTC member/regular attender who can provide a character reference. If you are new to HTC, please provide a reference from your last church. Name First Name Last Name Email Personal History In order to ensure the health, safety, and security of our children, we reserve the right to screen our volunteers. Please check the appropriate answers below so we may discuss how this may impact your serving in Kid City. Health Problems * Are there any health issues (disabilities, physical limitations, etc.) that might affect your work with chilren? Yes No Addictions * Have you ever had a problem with drugs, alcohol, pornography, or any other addiction, or has anyone ever suggested that you may have a problem with any of these things? Yes No Arrest Record * Do you have an arrest record? Yes No If you answered "yes" to any of the above 3 questions, please tell us more: Child Abuse * Have you ever been convicted or accused of physical abuse, sexual abuse, neglect, molestation, or exploitation of a minor? Yes No Authenticity, Authorization, and Background Check I authorize Holy Trinity Church or its representatives to make any and all appropriate inquires regarding my background, and I release the church and its representatives from any liability which may result from such actions. I understand that by typing my name in the space below this is a legally binding equivalent of a traditional handwritten signature. I certify that the information I have provided in this profile is correct to the best of my knowledge. SSN * Social Security Number is required for background check. Signature * First Name Last Name Thank you for your interest in serving with our family ministries! One of our staff members will be in touch once the background check and screening process are complete.
