Date of Birth:*
Primary Phone (or best contact number):*
Other Phone:
Other Phone:
Email:
As a member or volunteer, please tell us:
How long have you attended Bethany Church?
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?
Have you ever been accused of or been charged with any conduct that could be regarded as sexual misconduct?
Have you ever been convicted of, or plead guilty to, or are charges pending concerning, any felony?
Do you have any contagious disease, health issues, or history of emotional illness that would currently place children, other workers, or yourself at risk?
Do you have a history, either personally or in your family background, of: alcohol abuse, drug abuse, physical abuse, or sexual abuse?
Have you ever been concerned or has anyone ever suggested you may have an addiction to drugs, alcohol, pornography, or any other addiction?
Have you ever been treated for a psychiatric disorder?
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?
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?
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 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:
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: