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Kids & Youth Volunteer Form

Use this form if you are an adult (18+) interested in volunteering with kids & youth (which requires additional screening & a Vulnerable Sector check).

Your name *

Last name

Email address *

FOR ADULTS MINISTERING TO CHILDREN & YOUTH AT PHILPOTT CHURCH

In our desire to reduce the risk of abuse within our church ministries, we believe this information is necessary to protect our children, our youth and our volunteers and to effectively place our volunteers in ministry positions. Thank you in advance for your partnership.

Birthdate

Gender

Address

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Phone number

Phone type

Photo *

Please submit a recent photo of yourself along with your completed application

No file currently selected

Choose 1 file. Maximum file size 10 MB.

What areas are you interested in helping out with? (please check all that apply) *

Thursday Evening Youth Group (6:00-9:00pm every Thursday along with additional activities during the year)

Sunday Morning Kids Church Upper Elementary (Grades 3-6)

Sunday Morning Kids Church Early Elementary (JK - Grade 2)

Sunday Morning Nursery (Babies & Toddlers)

Summer Camp VBS

Occupation and/or Employer if applicable *

Hobbies, Interests, or Skills *

How long have you attended Philpott Church? *

When did you become a follower of Jesus? *

In a brief paragraph, please outline your spiritual journey. *

Please list any gifts, training, education, or other qualifications that we can help nurture in a volunteer role.

Do you require any special accommodations? How can we best support you in a volunteer role?

Previous Churches Attended

Churches I attended in the last five years are as follows (please provide info for all that apply):

Church 1

Name of Church? *

Address of Church *

Dates Attended: *

Church 2 (if applicable)

Name of Church?

Address of Church

Dates Attended:

Church 3 (if applicable)

Name of Church?

Address of Church

Dates Attended:

Present/Previous Ministry Info

My present and previous ministry experience is as follows:

Name of Church/Organization

Dates & Description of Ministry

Pastor or Ministry Supervisor

Name of Church/Organization

Dates & Description of Ministry

Pastor or Ministry Supervisor

Confidential Information

In order to provide a safe and secure environment for our children and youth, we believe it is necessary to include the following questions as part of our application process. All information will be kept confidential by church leadership and the Plan to Protect team. (Police may access this information, under warrant, if requested.) Answering yes to any of the questions will not necessarily preclude your involvement in ministry. Thank you in advance for your understanding.

Are there any circumstances involving your lifestyle or background that would call into question your ability to work with children or youth? *

Yes

Have you ever been accused of impropriety with children or youth? *

Yes

Have you ever been convicted for the use or sale of illegal drugs? *

Yes

Have you ever been through treatment for alcohol or substance abuse? *

Yes

Have you ever been convicted of a criminal offence (excluding minor traffic violations)? *

Yes

Have you ever been arrested or convicted for any abuse related crimes? *

Yes

Have you been investigated by the Child Welfare Agency for suspected child abuse? *

Yes

Have you ever been the subject of a civil lawsuit involving sexual harassment or other immoral behaviour or conduct involving children, youth or adults? *

Yes

Have you ever been the subject of any disciplinary action, transfer or dismissal, or been named as a defendant in a civil or criminal lawsuit as a result of an accident or mishap involving children or youth? *

Yes

Have you ever been subjected to expulsion, reprimand, or other discipline by a church, denomination or other religious organization? *

Yes

Have you ever been the subject of any disciplinary action (including discharge) or investigation by a church, religious or other organization, or by an employer? *

Yes

If you have answered yes to any of the above questions, please explain below:

I consent to a Vulnerable Sector Check *

All volunteers working with children & youth need a Vulnerable Sector Check completed prior to serving at the church.

Volunteers working with children and youth will complete Plan to Protect training prior to serving at the church. *

Please note: our training will cover issues of childhood physical and sexual abuse. If this is difficult to face because of your own past experiences, please let us know if we can be of help.

References

Please provide the names of three individuals, excluding relatives, who could provide a reference for you. Include at least one reference from outside the church.

Reference 1

Name *

Phone # *

Email Address *

Nature of Relationship *

Reference 2

Name *

Phone # *

Email Adress *

Nature of Relationship *

Waiver Details

Please provide your electronic signature (full name) indicating you've read and agree to the statement in the description of this question. *

If given the opportunity, I hereby consent to participate as a volunteer at Philpott Church.

I, named below, undertake and agree to indemnify and hold blameless the Ministry Staff, Philpott Church, its Pastors and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Philpott Church, as well as of any medical treatment authorized by the supervising individuals representing the church. This consent and authorization is effective only when participating in or traveling to events of Philpott Church.

The safety of our volunteers is of primary concern. Precautions will always be taken for their well-being and protection.

RELEASE OF INFORMATION AND DECLARATION OF INTENT

Please provide your electronic signature (full name) indicating you've read and agree to the statement in the description of this question. *

I give Philpott Church consent to verify the information provided herein.

I hereby give Philpott Church permission to contact persons named as references to ascertain my suitability for volunteer ministry. I release all such references from liability for any damage that may result from furnishing such evaluations to you.

I also grant my permission for Philpott Church to perform a police records check, for purposes of my protection against any false allegations and for the protection of those I serve. I consent to such an investigation with the understanding that the results will be kept in strict confidence. I agree to adhere to the protection policies as adopted by this church.

I understand that if my character or morals are deemed by church leadership to be inappropriate and/or criminal at any time during my volunteer service, Philpott Church will be entitled to terminate my assistance without expressed cause or prior notice regardless of any other oral or written statement by Philpott Church prior to, at, or following the date of volunteer service.

I understand that Philpott Church is responsible for the welfare of any person or persons entrusted to my care. I will cooperate fully with the staff in the fulfillment of my duties and will keep all information I encounter, in my role as a volunteer, confidential. If at any time I find that for any reason I am unable to support the policies, procedures or doctrine of Philpott Church, I will gracefully and quietly resign my volunteer position. If my supervisors find that I am in conflict with any of the policies, procedures or doctrines and we are not able to resolve the issue, I will gracefully and quietly agree to resign my volunteer position. I hereby acknowledge that, to the best of my knowledge, the information contained in this application for volunteer ministry is true and correct.

Please provide an electronic signature of a witness (full name) indicating they have read and agree to the information provided in the entirety of this form. *

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Philpott Church
info@philpottchurch.ca
905-523-7000