Pathfinder Volunteer Data Sheet: UPDATE

Pathfinder Volunteer Data Sheet: UPDATE

This form only needs to be filled out every three years. (After the initial Pathfinder Volunteer Data Sheet is completed.) Thank you for assisting us in maintaining accurate and current information.
Section I
Name *
Birthdate *

Month Day Year
E-mail
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone *

Area Code Phone Number
Work Phone *

Area Code Phone Number
Church *
Pathfinder Club *
Marital Status *
Name of Spouse
Are you presently an Pathfinder staff member? *

Yes No
What position in the club do you hold?
Section II
List any injury/disability/health factor that might limit your involvement in ministry activities, or impact the health of children (i.e. communicable disease, physical limitation.
Have you ever been convicted of a felony? *

Yes No
Have you been denied legal custody of your children in any legal proceedings, including divorce Decrees or settlements? *

Yes No
Have you ever been accused of, charged with, disciplined for, or convicted of any unlawful sexual conduct, abuse, child abuse, child neglect, and/or child sexual abuse? *

Yes No
Have you been required to register as a sex offender in any jurisdiction? *

Yes No
If you answered yes, please supply the date, place, type of conduct, disposition and a sentence as applicable.
Section III
Applicant’s Social Security Number *
Birth Date *

Month Day Year
The above information is accurate to the best of my recollection. I understand this is strictly a volunteer position and I will receive no remuneration for services and time volunteered. I also give my permission for the Ohio Conference to run another background check on me.: Applicant’s Signature of Consent *

Clear
Date of Signature *

Month Day Year
Should be Empty:

Pathfinder Volunteer Data Sheet: UPDATE

Section I

Section II

Section III