NM NazSafe Children and Youth Worker Pastoral Approval

Children and Youth Worker Pastoral Approval

New Mexico District Church of the Nazarene - NazSafe Program
Thank you for being willing to provide a Pastoral Recommendation for one of our Camp Counselors or Workers. Please fill out the information requested and then press the Submit button.

If you wish to print out a copy for your records, press the Print button before you Submit the form.
Applicant's Name*

First NameLast Name
Pastor's Name*

First NameLast Name
Church Name*
Phone Number*

Area CodePhone Number
Your E-mail
YesNo
YesNo
Date completed background check

MonthDayYear
Date
YesNo
Date completed Sexual Abuse Awareness training

MonthDayYear
Date
YesNo
Comments:
Signature - Use computer mouse to sign (or finger/stylus if using a touch screen).*

Clear
Should be Empty: