Family Hope Volunteer Application

Volunteer Application
Applicant #1- Primary Contact
Name

First NameLast Name
What church do you attend?
How long have you attended?
Church Website
Which of the following does your family participate?

Regular Church AttendanceSmall GroupService/Mission Activities
Primary Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth
Gender

MaleFemale
Race/Ethnicity/Nationality
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Highest Level of Education Achieved
Current/Most Recent Employer, Job Title, and Length at Job
Have you been involved in a child abuse/neglect allegation or investigation?
Have you ever been arrested?
Have you ever been involved in a domestic violence incident?
Have you ever had a substance abuse or alcohol problem?
Do you have any mental or physical health concerns that would impact your ability to care for a child?
Do you smoke?
Briefly share your upbringing, family relationships, siblings, and family rules.
What method(s) of punishment was(were) used in your family when growing up?

Loss of PrivilegesTime Out/GroundingSpankingOther
Has any of the following occurred in your family of origin?

Mental/Physical AbuseDrug AbuseAlcohol AbuseSexual Abuse
Are you married?

YESNO
Applicant #2- Spouse
Name

First NameLast Name
Spouse's Phone Number (Secondary Contact Number)
Please enter a valid phone number.
Email
example@example.com
Date of Birth
Gender

MaleFemale
Race/Ethnicity/Nationality
Highest Level of Education Achieved
Current/Most Recent Employer, Job Title, and Length at Job
Have you been involved in a child abuse/neglect allegation or investigation?
Have you ever been arrested?
Have you ever been involved in a domestic violence incident?
Have you ever had a substance abuse or alcohol problem?
Do you have any mental or physical health concerns that would impact your ability to care for a child?
Do you smoke?
Briefly share your upbringing, family relationships, siblings, and family rules.
What method(s) of punishment was(were) used in your family when growing up?

Loss of PrivilegesTime Out/GroundingSpankingOther
Has any of the following occurred in your family of origin?

Mental/Physical AbuseDrug AbuseAlcohol AbuseSexual Abuse
Children and Family Members
Do you have children?

YESNO
Do your children live in your home?

YESNO
If planning to host children in your home, please list all individuals apart from you (and your spouse) who currently live in your home

Also include anyone (18+)
First Name Last Name DOB MaleFemale If other please explain: Ethnicity
First Name Last Name DOB MaleFemale If other please explain: Ethnicity
First Name Last Name DOB MaleFemale If other please explain: Ethnicity
First Name Last Name DOB MaleFemale If other please explain: Ethnicity
First Name Last Name DOB MaleFemale If other please explain: Ethnicity
Relationship between Siblings:
Health of Child(ren):
Behavior of Child(ren):
Discipline:

Loss of PrivilegesTime Out/GroundingSpankingOther
List any special needs of child(ren):
Child(ren)’s view of having a Family Hope guest in your home:
Family Life
MOTIVATION: (Discuss reasons for wanting to become part of Family Hope)
How many years have you been married?
How did you meet?
Have you been separated at anytime?
Has there been any domestic violence in the marriage?
Please describe the strengths of your marriage.
Please describe the areas in need of growth in your marriage.
Have either of you been previously married?
List your favorite family hobbies, activities, and interests:
Values and beliefs of your family: (what’s important to your family?)
Are you involved in any other areas of child welfare? Select all that apply

Licensed Foster Parent(s)Safe Families for Children Volunteer(s)Private Adoption Family
Cultural Experiences and Values: (Discuss any experiences with different cultures, discrimination, and prejudice during childhood and adulthood.)
Support System: How often do you have contact with Family, Friends, and Neighbors:
Extended Family:
Neighbors:
Church Family:
Who can help with childcare?
If you had a crisis, who would you call?
What resources are in your community?
Home Description

Please fill this out if you are planning to care for children inside of your home.
Tell us about your construction

1 Story Home2 or More Story HomeApartment/TownhomeMultifamily Home/Duplex
Type of Arrangment

OwnRent
Indoor Space

1 BR2 BR3 BR4+ BR
Outdoor Space (Select all that apply)

Play EquipmentPatioDeckFence
Are there any pets in the home?
Is(are) the pet(s) friendly to children?
Are there any firearms in the home? If YES, describe the purpose and function and where firearms are stored.
Water Source

Munciple/City WaterWell/Ground Water
Do you have a swimming pool? If YES, describe if it is above or below ground and what safety measures you use:
Do smoke detectors and carbon monoxide detectors work?
Is hot water tank temperature set to avoid scalding?
Are cleaning supplies and chemicals out of reach or secured?
Do all unused electrical outlets have safety plugs/covers?
Please list the number of bedrooms with room measurements and tell who occupies each bedroom:
Will household vehicles be used to transport children?
Does the applicant(s) have proof of insurance and a valid driver’s license for vehicles used to transport children?
Do all other approved household members have proof of insurance and a valid driver’s license for vehicles used to transport children?
List all household members approved to transport children:
References

Please list 3 Non-Family References (Pastor, Friend, Colleague)
Reference #1- Pastoral / Church Staff
Name (First and Last)
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Reference #2- Non-Family Member
Name (First and Last)
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Reference #3- Non-Family Member
Name (First and Last)
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Tell us which way(s) you are interested in volunteering? Select all that apply.

Overnight Host Family (temporary hosting of children overnight in my home)Day Host Family (temporary hosting of children in my home; no overnights)Support Friend (transportation needs, tutoring, mentoring etc.)Sweet Water Mentor
Should be Empty:

Volunteer Application

Applicant #1- Primary Contact

Applicant #2- Spouse

Children and Family Members

If planning to host children in your home, please list all individuals apart from you (and your spouse) who currently live in your home

Family Life

Support System: How often do you have contact with Family, Friends, and Neighbors:

Home Description

References