Worthy Redeemer Kids Student Worker Application

Worthy Redeemer Kids Student Worker Application
This form is to be completed for any position involved in the supervision or care of children. This is being used to help provide a safe and secure environment for the children, volunteers and the church.
Last
First
Middle
Parent/Guardian Last Name
Parent/Guardian First Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If less than one year, previous address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Email
example@example.com
Cell or Home Phone
Parent Phone
Parent email
example@example.com
Best way to contact you
I have attended Worthy Redeemer Church since (approx. mo./year)
What age group do you most enjoy working with?

Toddler class (1-4s)K-3
Please list any previous experience, paid or volunteer, involving children or youth.
Why do you want to volunteer in Worthy Redeemer Kids?
Please list all churches you have regularly attended during the past five years
Church name City State Phone # Years Attended
Church name City State Phone # Years Attended
Church name City State Phone # Years Attended
Please provide personal references for each of the following.
Gospel Community Host or Student Small Group Mentor
Name
Email
example@example.com
Phone
Adult, other than a family member, who knows you well
Name
Email
example@example.com
Phone
Adult, other than a family member, who has observed you interacting with children
Name
Email
example@example.com
Phone
By completing this application, I give Worthy Redeemer Church full approval to discuss with the references I've provided any interactions I've had, positive or negative, with children in the past.
Should be Empty:

Worthy Redeemer Kids Student Worker Application

Please list all churches you have regularly attended during the past five years

Please provide personal references for each of the following.