Butler First Assembly of God Volunteer Information and Background Check

Butler First Assembly of God Volunteer Information and Background Check

This form will be required to serve in kids ministry.
2024 VBS Release and Indemnification

By signing this form I First Name Last Name am acknowledging that I have heard and understand the VBS Policies and Procedures presented to me by First Assembly of God Church. I agree to follow all policies and procedures laid forth in this meeting or document. I further agree to indemnify and hold harmless First Assembly of God Church, it’s Pastor, Board and Staff against any and all claims that name me as having abused or mistreated any child or vulnerable adult with who I had contact through my involvement with First Assembly of God Church. A copy of the policies and procedures can be obtained upon request.
By typing your name you are agreeing to the information above.
First Name Last Name Date
Applicant Name

First NameMiddle NameLast NameMaiden Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Place of Birth
Birthdate

MonthDayYear
Date
Gender
Drivers License
State
Do you have a photo ID?
SSN#
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
- I, the applicant, agree with the following statement:
- Date
  
  MonthDayYear
  Date
- Signature of Applicant
- Should be Empty: