Mentor & Volunteer Form

Mentor & Volunteer Form

The heart of our program is to provide a safe place for youth to experience the hope, healing, and love of Jesus Christ.
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityProvince

Postal / Zip Code
Email*
example@example.com
Home Phone Number:*
Please enter a valid phone number.
Cell Phone Number:
Please enter a valid phone number.
Birth Date: *

MonthDayYear
Date
Emergency Contact Name: *

First NameLast Name
Phone Number:*
Please enter a valid phone number.
Medical Information in Case of Emergency:*

Qualifications and Experience
Do you have any experience with children/youth? Yes or No. *
If yes, how many years and explain your role and responsibilities: *
Are you currently First aid Certified?*

YesNo

Faith

As a Christian organization our core purpose is to share the hope, love and saving grace of Jesus Christ in a broken world.
Are you a member of a church?*

YesNo
If yes, name of Church:
Have you accepted Christ as your Saviour?*

YesNo
Please provide a full statement of faith: *

Information About Working with Children and Youth
In order to provide a safe and secure environment for our participants, we believe it is necessary to ask the following questions as part of our application process. All information will be kept confidential by River’s Edge and will not be disclosed unless required by law. Answering ‘yes’ to any of the following questions may not necessarily prevent you from volunteering at River’s Edge. Thank you in advance for your understanding.
Are there any circumstances involving your lifestyle or history that could call into question your ability to work safely with children?*

YesNo
If Yes, Please Explain:
Have you every been convicted or found guilty of a criminal offense?*

YesNo
If Yes, Please Explain:
Have you ever been expelled from or had your employment terminated by any organization or employer for assault or violence against any person, or for assault, violence or impropriety with children, youth or vulnerable persons?*

YesNo
If Yes, Please explain:
Do you have any contagious diseases or conditions of which we should be aware, and which we may need to take steps to protect against transmission should you volunteer at River’s Edge?*

YesNo
If Yes, Please Explain:

References
Please provide 2 professional references (work, volunteer, church, etc.) from someone you have known for at least 2 years; not to include family members.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Length of time they have known you:*
Relation to you: *
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Length of time they have known you: *
Relation to You: *

RELEASE OF INFORMATION AND DECLARATION OF INTENT
I hereby give River’s Edge consent to verify the information provided by me in this application and to contact the references listed and to obtain and verify any information from them that may be relevant to this application.

I understand that if River’s Edge approves my volunteer application and later determines at any time that I am not suitable for volunteer service at River’s Edge or for the position for which I am applying, River’s Edge may terminate my volunteer service.

River’s Edge requests the right to use any photo and/or film of me, that may be published in any River’s Edge publication/film/website or any other media item. I realize that any photo(s) and/or film taken will be used for promotional use only and will not be distributed beyond this use.
blanks*I give my consent to the Release of Information & Declaration of Intent
blanks I DO NOT give my consent to the Release of Information & Declaration of Intent
All staff and volunteers at River’s Edge must submit a Vulnerable Sector Police Check dated within 3 months of today's date prior to their start date. This can be obtained either in person or on-line. Please note the minimum length of time for the OPP to process this request is 10 business days.

If at any time I determine that for any reason I am unable to support or follow the Policies and Procedures at River’s Edge, I will inform my supervisor and resign my volunteer position.
blanks* I understand and agree to adhere to the Volunteer Code of ethics at River's Edge.
Signature of Applicant: *

Clear
Full Name*

First NameLast Name
Date: *

MonthDayYear
Date
Thank you for your application!

You will hear from us shortly!
Should be Empty:

Mentor & Volunteer Form

Qualifications and Experience

Skills and Interests

Availability

Faith

Information About Working with Children and Youth

References

RELEASE OF INFORMATION AND DECLARATION OF INTENT

Thank you for your application!

You will hear from us shortly!