Kid’s Ministry Volunteer Form Groups Men Women Students Kids Prayer Global Impact Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Email PhoneBirthdate Volunteer InformationMarital Status Occupation Place of Employment Additional SkillsAre you CPR certified or do you have any medical training?List any other skills (such as sign language or if you have ever worked special needs childer, etc.)List education, experience, or interests that might enhance your participation in ministry:Ministry/ Service HistoryHow long have you regularly attended Two Rivers Church?1-3 months4-11 months1-2 years2+ yearsList churches attended in the past five years (include dates attended and reason for leaving):List any ways that you have served in churches previously:Your Story/ Personal TestimonyHave you personally accepted Jesus Christ as your Lord and Savior?* Yes No Have you committed to having the character of Jesus live through you?* Yes No Write a brief testimony of how you became a Christian:*(no longer than 500 words)Briefly describe your motivation for wanting to serve in this ministry:What area of ministry are you most interested in?(check all that apply) Birth- 2 years Preschool 1st-5th grade Security Check-In/ Floater Confidential StatementsIf you prefer, you may discuss these statements in person with a member of the pastoral staff. Answering "yes" does not automatically disqualify an applicant.Have you ever been convicted of a criminal offense (felony or misdemeanor, except for minor traffic violations)? You will need to answer "yes" if you have entered into a plea agreement, including a deferred judgement arrangement, in connection with a criminal charge. Yes No If you have been convicted of such an offense, please attach a statement of explanation, including nature of the offense, date, court, where conviction was entered, and any other relevant information. You do not need to disclose information contained in sealed or expunged records.Have you ever been charged with a sexual offense, offense related to children, or crime of violence? Yes No If you have been convicted of such an offense, please attach a statement of explanation, including nature of the offense, date, court, where conviction was entered, and any other relevant information. You do not need to disclose information contained in sealed or expunged records.Have you ever been reported to a social services agency, law enforcement authority, child abuse registry, or simillar organization regarding abuse or misconduct involving children? Yes No Have you ever been subjected to expulsion, reprimand, or other discipline by a church, denomination, or other religious organization? Yes No Have you ever been the subject of a complaint or disciplinary proceeding against a professional license or other license held by you, including but not limited to a license to provide childcare or similar services? Yes No Have you ever been the subject of a civil lawsuit involving sexual misconduct, sexual harassment, or other immoral behavior or conduct, involving adults or children? Yes No Have you ever been the subject of a complaint or 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? Yes No Have you ever been subject to any disciplinary action (including discharge) or investigation by a church, religious or other organization, or by an employer? Yes No Have you ever been concerned that you may have an addiction to drugs, alcohol, or pornography or any other addiction? Or has anyone ever suggested that you may have a problem with any of the above? Yes No If you answered yes to the question above, please explain:Do you have any health problems (eg, disabilities, physical limitations, etc.) that might affect your work with children? Yes No If you answered yes to the question above, please explain:Have you ever been a victim of abuse or molestation? Yes No Have you ever tested positive for HIV? Yes No Personal ReferencesMust be over 18 and not a relative.Name First Last Relationship to Applicant Length of Time Known PhoneEmail Name First Last Relationship to Applicant Length of Time Known PhoneEmail Applicant's StatementI have received and reviewed a copy of Two Rivers Church's Safe Kids' Manual. I agree to abide by the policies outlined in this plan, and to refrain from unscriptural conduct in the performance of my services on behalf of this church. The information contained in this volunteer profile is correct to the best of my knowledge. I authorize references or churches listed in this profile to provide my information, including opinions they may have regarding my character and fitness for ministry. I release all such references from any and all liability for furnishing such evaluations, provided they do so in good faith and without malice. I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand. Applicant's Electronic Signature: Date MM slash DD slash YYYY
