KidZ at Heart Board Member Application

KidZ at Heart Board Member Application
1. Personal & Family Information
Name*

First NameLast Name
Preferred Name / Goes By*
Phone Number*

Area CodePhone Number
Phone Type*
Email*
example@example.com
Best method of contact for you (check any that apply):

TextEmailPhone call
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date (Month/Day)*
Spouse's name (if applicable):

First NameLast Name
Preferred Name / Goes By
Children's names and ages (if applicable):
Number of grandchildren (if any):
Citizenship*
Emergency Contact Name*

First NameLast Name
Emergency Contact's Relation to You*
Emergency Contact's Phone Number*

Area CodePhone Number
Emergency Contact's Email*
example@example.com
2. Education & Special Skills
What special skills do you bring to an organization that trains church leaders, families, and children's workers in the spiritual formation of children?*
List diplomas, degrees, certificates or specialized training you have received and year earned.*
What other life experiences prepare you to serve on this board?*
3. Employment
Employment status (check one):

EmployedRetiredSelf-employed
Current or most recent employer*
Responsibilities at current or most recent employer*
What has been your primary occupation as an adult?*
What skills from your work experience will you bring to the board?*
4. Church Involvement
Church Name*
Church City*
Pastor's Name*
Pastor's Email*
example@example.com
Can we contact your pastor if needed?*

YesNo
How are you currently involved in ministry at your church?*
What other ministry experiences have you had?*
How have you been active with KidZ at Heart in the past? And, if so, for how long or how frequently?*
5. Personal History
Are you a Christian?*

YesNo
If yes, share your spiritual / faith journey. How did you come to faith in Jesus Christ?*
How would you describe your relationship with God at this time?*
Describe your personal spiritual disciplines at this time. (How do you spend time with God?)*
What specific gifts, abilities, and skills do you believe God has given you?*
How have you seen your gifts used by God?*
6. Children's Ministry Experience
Have you been involved in children's ministry or other activities focused on children?*

YesNo
If yes, how have you been involved and when was that?*
How do you believe a child comes to faith?*
7. Board Involvement
Why do you want to become a KidZ at Heart International Board Member?*
Describe your involvement with boards currently or in the past.*
Are you able to faithfully attend online board meetings (normally 9-11 a.m. AZ time on a Monday morning in March, June, and November)?
Are you able to attend two in-person Board retreats annually (somewhere in the US, normally Thursday dinner through Saturday early evening in September and January, in one of the Board member's cities of residence)?
8. Agreements with Policy / Program
Please read the documents listed below. All board members are expected to abide by these policies, procedures, and values while ministering on behalf of KidZ at Heart. Please indicate your agreement and willingness to abide by each below.
Board Member Ministry Description
Choose one:*

I agree fullyI agree partiallyI do not agree
KidZ at Heart's Statement of Faith
Choose one:*

I agree fullyI agree partiallyI do not agree
KidZ at Heart's Community Covenant
Choose one:*

I agree fullyI agree partiallyI do not agree
KidZ Beliefs (Core Values and Position on Children and Spiritual Formation)
Choose one:*

I agree fullyI agree partiallyI do not agree
KidZ at Heart's Ministry Model
Choose one:*

I agree fullyI agree partiallyI do not agree
9. Required Screening Information
Although KidZ at Heart does not work directly with children, we believe that all board and staff members and all trainers need to be screened just as a local church’s children’s ministry volunteer would be screened – to protect children, the organization, and the individual. Thank you for your willingness to answer these confidential questions.
Have you ever participated in, been accused of, been charged with, plead no contest to, or been convicted of any of the following:*

Child abuse or molestation or any crime or improper conduct involving a minor?Any sort of illegal, immoral or inappropriate sexual activity?Any other crime (other than traffic violations)?None
Are you aware of any reason why you should not work with children or youth, including your own personal traits or tendencies?*

YesNo
Do you engage in the use of any form of pornography?*
Do you misuse any form of alcohol, prescription drugs, hallucinogens, or other addictive substances?*
Is there anything in your background or spiritual life (not already listed above) that might compromise the message of the gospel in any way or that the leadership of KidZ at Heart should know about before making you a part of the KidZ at Heart community?*
If you answered "Yes" to any of the above questions, please list below and explain. Or if you prefer, you may contact the KidZ at Heart Board Chairman.
In addition to the above screening questions, we ask that each board candidate complete an online background screening. The screening costs approximately $10, which KidZ at Heart will reimburse if you would so desire.
10. Verification of Accuracy & Authorization for Release of Information
I recognize that KidZ at Heart International is relying on the information contained in this application. Accordingly, I attest and affirm that all of the information that I have provided KidZ at Heart (in this and all other steps of the application process) is absolutely true and correct.

I authorize KidZ at Heart International to contact any person or entity listed in this application, and I further authorize any such person or entity to provide KidZ at Heart with information, opinions, and impressions relating to my background, qualifications, character, or fitness for work with children or youth or in ministry leadership. I voluntarily release KidZ at Heart and any of its agents and any such person or entity who provides this information from all liability involving the communication of such information relating to my background, qualifications, character, or fitness for work with children or youth or ministry leadership. I further authorize KidZ at Heart to conduct a criminal background investigation.

I waive any right that I may have to inspect references provided on my behalf. I further agree to allow personal information about me to be discussed as necessary between the President, Board of Directors, and key staff members of KidZ at Heart, and with any legal counsel obtained by KidZ at Heart. I also understand that KidZ at Heart volunteers may assist in reviewing applications and making reference calls.

I agree to abide by all policies and procedures of KidZ at Heart International and to submit to the authority of the President and the Board of Directors. I further agree to refrain from unscriptural, immoral, or illegal conduct while I am considered a part of the ministry staff of KidZ at Heart.
Authorize / Do Not Authorize?*
Signature*

Clear
Should be Empty: