The Harvest Volunteer Application

1. Name*

First NameLast Name

2.Phone Number*

Please enter a valid phone number.

3. Email*

example@example.com

4. In which programs(s) do you want to serve in?*

5. WHAT OTHER CHILDREN’S/YOUTH WORK EXPERIENCE DO YOU HAVE?(Please list: Organization/Program, Dates, Contact)

6a. Been convicted of, or pleaded guilty or no contest to, any crime?*

YESNO

6b. Participated in, or been accused, convicted, or pleaded guilty or no Contest to abuse or any sexual misconduct?*

YESNO

7a. Having any traits or tendencies that could pose any threat to children, youth, or others?*

YESNO

7b. Any reason why you should not work with children, youth, or others?*

YESNO

If the answer to any of these questions is “yes,” please explain in detail below:

8. CHURCH ACTIVITY | What church or churches have you attended in the past five years? (Please list the church name, Leader Pastor's name, and years attended)*

Name #1*

First NameLast Name

Relationship*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name #2*

First NameLast Name

Relationship*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I recognize that The Harvest is relying on the accuracy of the information I provide on the Children/Youth Ministry Volunteer Application form. Accordingly, I attest and affirm that the information I Have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on the Children/Youth Ministry volunteer Application form, and I further authorize any such person or entity to provided the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the organization and any such person or entity listed on the Children/Youth Volunteer Application form from liability involving the communication of information relating to my background or qualifications.

I have carefully read the policy and procedures of the organization, and I agree to abide by them and to protect the health and safety of the children or youth assigned to my care or supervision at all times.

MINOR APPLICANTS

Parental Affirmation and Consent

I affirm that I am the parent/legal guardian of the applicant. I recognize that The Harvest is relying on the accuracy of the information provided. To the best of my knowledge, I affirm and attest that the information provided is true and correct. I further attest and affirm that I am aware of no traits or tendencies of my child/legal dependent that could pose any threat to children, youth, or others.

Signature of Applicant *

Date*

Date

Parent or Legal Guardian Name

First NameLast Name

Parent or Legal Guardian Signature

Date

The Harvest Volunteer Application

6. Have you at anytime ever:

7. Are you aware of:

9.SUPPLY AT LEAST TWO INDEPENDENT REFERENCES

FOR MINOR'S ONLY