Re-certification of current AMIAS's

AMIAS Re-certification

This is ONLY for Current AMIAS's. After completing both pages of this form, be sure to push the "Submit" button on the bottom of the second page. We use this form submission software because it works, however our use is not an endorsement of it.
Date

MonthDayYear
Date
Name

First NameLast Name
Home address

Street address 1

Street address 2

CityState

Zip Code
Phone Number-Mobile

Area CodePhone Number
Phone Number- Home

Area CodePhone Number
Email
example@example.com
Alateen group you work with?
District

By typing my name below, I certify that:

1. I am at least 21 years old.

2. I have been actively attending Al-Anon meetings for a minimum of two years (in addition to any time I may have had in Alateen) and attend at least one Al-Anon meeting per week.

3. I have not been convicted of a felony, and not have been charged with child abuse or any other inappropriate sexual behavior, and not have demonstrated emotional problems which could result in harm to Alateen members. I have not had a final Protective or Peace Order issued against me.

4. I agree not have overt or covert sexual interactions (whether consensual or not) with an Alateen member, including but not limited to: touching a teen inappropriately; dating a teen who is an Alateen member; holding or hugging an Alateen member in an inappropriate manner.

5. I agree to allow the Area Alateen Process Person (AAPP) or person designated by AFG of MD and DC, Inc., at his/her option to independently verify the information I have presented on this Application, which may include checking references and criminal history records.

6. I understand that any information obtained will be securely stored and protected by the Area Alateen Process Person (AAPP).

7. I have read and understand the Safety and Behavioral Requirements and Guidelines as published by AFG of MD and DC, Inc. as well as any Safety and Behavioral Requirements and Guidelines published by the World Service Organization (WSO) and I agree to perform my work in Alateen in accordance with them.

8. I understand that as an Al-Anon Member Involved in Alateen Service (AMIAS), my primary goal is to help the Alateen members follow the Al-Anon/Alateen program. Should anything interfere with this objective, i.e., accusations, controversy, threats of personal harm, etc., I will discontinue serving in this position immediately. Even if I feel totally blameless, I understand my removal from the situation will protect the Alateen members and preserve the unity of the fellowship as well. I understand that stepping away from sponsoring an Alateen group or being involved in Alateen service is not an admission of guilt.

9. I agree to hold harmless from liability the AAPP, AAC (Alateen Area Coordinator), Alateen group, AFG of MD and DC, Inc. its officers and volunteers, the World Service Organization and its officers, employees and volunteers. I understand that these organizations are not under any obligation to appoint me as an Al-Anon Member Involved in Alateen Service (AMIAS). If asked to resign my position for any reason, I will consider the safety of the Alateen members to be paramount and will resign.

BY TYPING YOUR NAME BELOW, YOU ARE CERTIFYING THAT YOU AGREE WITH THE ABOVE STATEMENTS AND THAT THEY ARE TRUE.
Certified by:*

First NameLast Name
Should be Empty:

AMIAS Re-certification