Student Impact Form

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

We're delighted that you would like to be a Student Volunteer at Bethany and want you to know that providing a safe, friendly and comfortable environment is a priority at Bethany. For this reason, we ask all volunteers to respond to the following questions.

This form is for anyone in 6th grade up to age 17 to fill out if they want to volunteer.

Full Name:
First Name
Last Name
Date of Birth:*
Address Line 1
Address Line 2
Postal Code
Primary Phone (or best contact number):*
Other Phone:
Other Phone:
I am applying to: *
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 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?
Are you in a Small Group/Cell Group?
For adults we conduct background checks (through "Protect My Ministry") for all volunteers. Do you you have any reason to believe that, if you were an adult, 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, please explain:
Have you ever been convicted of, or plead guilty to, or are charges pending concerning, any felony?
If yes, please explain:
Do you have any contagious disease, health issues, or history of emotional illness that would currently place children, other workers, or yourself at risk?
If yes, please explain:
Do you have a 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 you may have an addiction to drugs, alcohol, pornography, or any other addiction?
If yes, please explain:
Have you ever been treated for a psychiatric disorder?
If yes, please 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, please explain:
When you are volunteering in ministry, you will be part of a team committed to sharing the love of Jesus. This will mean that the ministry is your primary focus. Will you be able to focus completely on the ministry, even if there are other youth around?
Why do you want to work with children?
If a child were to ask you how to become a Christian, what would you say?
Please list ministry, a personal, or church reference (may not be a relative) who knows you well (has known you more than 6 months) whom we may contact. The pastor, a relative or director of the ministry for which you are applying cannot be used as a reference:
Reference Name:
First Name
Last Name
Reference E-mail (e-mail is our preferred means of contact; if e-mail not available, please list other means of contact):
Reference Cell Phone
Reference Home Phone:
Reference Work Phone:
Reference Address:
Address Line 1
Address Line 2
Postal Code
Nature/Length of Association with reference:
I recognize that, as a condition of my service, references will be contacted. I further authorize my references to give you any information they may have regarding my character and fitness for volunteering. 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 references provided on my behalf. I understand that if I have questions about the following Statement of Faith, Code of Ethics, any church policies, or any other aspect of my service with Bethany Church, I will contact a Director or Pastor for clarification and guidance. By signing below, I indicate that I have carefully read all of the information in this packet, know and understand the contents. I also acknowledge that all of the information I have provided is true and complete.
Electronic Signature:
Date Signed:

Parent consent

I have read this application and attest to its validity.  I understand that my child is applying to volunteer at Bethany Evangelical Free Church.

I believe my child will be an asset to the team:
If no, please explain:
I give my permission for my child to participate:
If no, please explain:
Parent's Electronic Signature:

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:

Electronic Signature:*
Date Signed:*