Impact Form

Impact (n. im-pakt; v. im-pakt): to have an impact on, to effect, to make a difference.

We are delighted that you would like to be a volunteer at Bethany and want you to know that providing a safe, friendly, and comfortable environment is a priority at Bethany Church. For this reason, we ask all volunteers to respond to the following questions, which are held in the strictest confidence. Additionally, after clicking on the “submit” button at the end of this form, you will be directed to click on a link to the Protect My Ministry website to complete information for a secure background check. Date of birth, driver’s license number, and social security number are required by Protect My Ministry to conduct a background check. Participating in the background check conducted by Protect My Ministry is required of all Bethany volunteers. Thank you for understanding and for wanting to have an impact!

This form is for everyone that is 18 or older and wants to volunteer.

Full Name:
First Name
Last Name
Date of Birth:*
If married, spouse's name:
If children, name(s) and age(s):
Address Line 1
Address Line 2
Postal Code
Primary Phone (or best contact number):*
Other Phone:
Other Phone:
I am applying to be:
As a member or volunteer, please tell us:
Ministries you have PREVIOUSLY served in:
Ministries you are CURRENTLY serving in:
Ministry you WOULD LIKE TO BE engaged in:
What do you do for a living?
What is your religious background (previous church involvement, how you were raised)?
What brought you to Bethany Church?
How long have you attended Bethany Church?
Have you personally accepted Jesus Christ as your Lord and Savior?
Please share your personal spiritual story. (Helpful Hints: When did you receive Christ? Where? How? Why?)
Describe your CURRENT WALK with Christ. What is He teaching you lately? How consistent is your devotional life?
How can Bethany Church best meet your needs?
If there is one thing you would improve about Bethany Church, what would it be?
We conduct background checks (through "Protect My Ministry") for all volunteers. Do you have any reason to believe a background check would disclose any negative information?
If yes, explain:
Have you ever been accused of or been charged with any conduct that could be regarded as sexual misconduct?
If yes, explain:
Have you ever been convicted of, plead guilty to, or have charges pending concerning any felony?
If yes, explain:
Do you have any contagious disease, health issues, or history of emotional illness that would currently place children, other volunteers, or yourself at risk?
If yes, explain:
Do you have any history, either personally or in your family background, of: alcohol abuse, drug abuse, physical abuse, or sexual abuse?
If yes, please specify and include what, if any, steps you have taken to minimize the impact those issues could create for you:
Have you ever been concerned or has anyone ever suggested that you may have an addiction to drugs, alcohol, pornography, or any other addiction?
If yes, explain:
Have you ever been treated for a psychiatric disorder?
If yes, explain:
Is there any circumstance or pattern in your life which would make it inappropriate for you to volunteer at Bethany Evangelical Free Church or would compromise the integrity of Bethany Evangelical Free Church?
If yes, explain:
Please list a personal, ministry, or church reference whom we may contact (someone who has known you for more than 6 months; may not be a relative or the pastor or director of the ministry for which you are applying):
First Name
Last Name
Reference email (email is our preferred means of contact; if email is not available, please list other means of contact):
Reference Cell Phone:
Reference Home Phone:
Reference Work Phone:
Nature/Length of association with reference:

I recognize that, as a condition to my volunteering, references will be contacted, a background check will be made and I willingly consent to all checks. I further authorize my reference to give you any information they may have regarding my character and fitness for volunteering in the church. I release Bethany Church and all such references from any and all liability for any damage that may result from furnishing such evaluations to you, and I waive any right that I may have to inspect reference provided on my behalf.

I understand that if I have questions about any aspect of my volunteering with Bethany Church, I will contact a Director or Pastor for clarification and guidance.

By signing below, I indicate that I have carefully read the foregoing release and that I know and understand the contents. I also acknowledge that all of the information I have provided is true and complete.

Digital Signature*
Date Signed:*

Bethany Church Child Protection Policy for Volunteers

At Bethany we ask that ALL VOLUNTEERS, regardless of the ministry they are serving in, be familiar with and abide by our Child Protection Policy.  It is our desire to bring children and youth to Jesus.  It is our prayer that they will not be hindered in anyway.  Because we recognize that we are a reflection of God's love to those in our care we take seriously our responsibility to them. Therefore we have developed guidelines for all volunteers to follow.  Please read this Child Protection Policy for Volunteers document, then provide your signature below. 

By signing below, I indicate that I have carefully read the Child Protection Policy for Volunteers document and that I know and understand the contents. 

Electronic Signature:*
Date Signed: *

Bethany Church Statement of Faith

  1. We believe the Scriptures, both the Old and New Testaments, to be the inspired Word of God, without error in the original writings, the complete revelation of His will for the salvation of men, and the Divine and final authority for all Christian faith and life. (II Timothy 3:16, II Peter 1:20, 21). 
  2. We believe in one God, Creator of all things, infinitely perfect and eternally existing in three persons, Father, Son and Holy Spirit. (Deut. 6:4, Gen. 1:1, 1 John 5:7; Matt. 3:16, 17; II Cor. 13:14). 
  3. We believe that Jesus Christ is true God and true man, having been conceived of the Holy Ghost and born of the Virgin Mary. He died on the cross, a sacrifice for our sins, according to the Scriptures. Further, He arose bodily from the dead, ascended into heaven, where, at the right hand of the Majesty on High, He now is our High Priest and advocate. (John 1:14; Gal. 3:13; Heb. 9:28; Acts 1:9; Heb. 9:10-12). 
  4. We believe that the ministry of the Holy Spirit is to glorify the Lord Jesus Christ, and during this age to convict men, regenerate the believing sinner, and indwell, guide, instruct and empower the believer for godly living and service. (John 6:13,14; John 16:11; Matt. 18:3; I Cor. 14). 
  5. We believe that man was created in the image of God but fell into sin and is therefore lost and only through regeneration by the Holy Spirit can salvation and spiritual life be obtained. (Heb. 2:7-9; Gen. 6:5). 
  6. We believe that the shed blood of Jesus Christ and His resurrection provide the only ground for justification and salvation for all who believe, and only such as receive Jesus are born of the Holy Spirit, and thus become children of God. (Heb. 9:22; I Peter 1:18, 19; II Tim 1:12). 
  7. We believe that the Lord’s Supper and Water Baptism are ordinances to be observed by the Church during this present age. They are, however, not to be regarded as means of salvation (I Cor. 11; Matt. 28:19; Acts 2:38, 41). 
  8. We believe that the true Church is composed of all such persons who through saving faith in Jesus Christ have been regenerated by the Holy Spirit and are united together in the body of Christ, of which He is the head. 
  9. We believe that only those who are thus members of the true Church shall be eligible for membership in the local church. 
  10. We believe that Jesus Christ is the Lord and Head of the Church, and that every local church has the right, under Christ, to decide and govern its own affairs. 
  11. We believe in the personal and premillennial and imminent coming of our Lord Jesus Christ and that this “blessed hope” has a vital bearing on the personal life and service of the believer. (Acts 1:11, I Thess. 4:16-18). 
  12. We believe in the bodily resurrection of the dead; of the believer to everlasting blessedness and joy with the Lord, of the unbeliever to judgment and everlasting conscious punishment. (John 5:28; Luke 24:36-43; I Cor. 15:20-24; Rev. 20:11-15). 

I have prayerfully read, agree with, and will support these statements in my service and teachings.

Electronic Signature:*
Date Signed:*

Code of Ethics

Please review the Code of Ethics below. We want you to be completely aware of our ethics and what we desire of a volunteer. We ask that you agree to these by signing your name below.

  1. I desire to model Christ-likeness in my entire behavior, especially as I serve in ministry at Bethany Church. I aim to demonstrate my love for the Lord Jesus, my gratitude for His grace and forgiveness, and testify to the power of the Holy Spirit working in me. 
  2. I desire to demonstrate respect, loyalty, patience, courtesy, and maturity. 
  3. I will treat people of all races, religions, and cultures with respect and consideration. 
  4. I will not abuse children/youth/adults, in any way, including but not limited to: 
    • Physical abuse – e.g. strike, spank, shake, slap 
    • Verbal/Mental abuse – e.g. humiliate, degrade, threaten 
    • Sexual abuse – e.g. inappropriate touch or exposure 
  5. I will not possess or use illegal drugs. 
  6. I will not possess or use alcohol or tobacco in the context of ministry 
  7. I will not use or tolerate profanity. 
  8. I understand that any violation of this Code or of the Child Protection Policy, in all respects, may be grounds for dismissal from volunteer service or other action by the Church. 

I have read, understand, and agree to adhere to the above Code of Ethics:

Digital Signature:*
Date Signed:*