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KID SAFE APPLICATION

Confidential: This application is to be completed by all applicants, starting in Youth and older, volunteer or compensated, who are involved in the supervision or custody of minors from infants through high school. Please note that the reference section is also required before applicant can be approved.

Your name *

Last name

Email address *

Phone number

Phone type

Personal Information:

Have you accepted Christ as Savior? *

YES

Are you a member of Connect Church? *

YES

List any experience you have had working with children as a volunteer or professionally: *

Do you have children of your own? *

YES

Have you ever been suspected, accused, charged or alleged to have committed an act of neglect, abuse, or molesting a child? *

YES

What area(s) of Kid's Ministries you would like to be a volunteer? *

Nursery (ages 0 thru 2)

PreK thru K (ages 3 thru Kindergarten)

Elementary (grades 1 thru 5)

Students (grades 6 thru 12)

Camp Connect VBS

Missions

Other

Applicant Statement: *

The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) they have regarding my character and fitness to work with children. I authorize the release of information contained in this application to any ministry of Connect Church whereby I seek a volunteer position. Should my application be accepted, I agree with Christ’s help to live a life that is pleasing to Him, and to be a godly example and role model to the children, their families, and other volunteers.

I further state that I have carefully read this forgoing release and know the contents thereof and sign this release of my own free act by checking the box "I agree with the Applicant Statement". This is a legally binding agreement that I have read and understand.

I agree with Applicant Statement

References:

This section MUST be completed! Please include two (2) references from persons who have knowledge of your experience working with children, either on a volunteer or compensated basis.

1. Name, Contact Number, Relationship to Applicant: *

Please fill in all information needed.

2. Name, Contact Number, Relationship to Applicant: *

Please fill in all information needed.

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