Brian Phipps

4/4/16
Special Event
Volunteer application
Last Name First Middle Maiden Name
Address
City State Zip
Home Phone Work Phone Cell Phone
Date of Birth (month day year) e-mail
Current drivers license number and state of issue Social Security Number
Confirmed by (Please sign and print) Date
Identity must be confirmed with a state drivers license or other photographic identification.

Christian Walk and Ministry Interest

Please share how you came to know Jesus as your Savior and how you are now
growing spiritually:

What ministry opportunities are you interested in? (Check all that apply)
Junior High Youth Senior High YouthOther (please describe
below):
Please indicate the date you would be available to begin:
Will you commit to regular ministry training? Yes No
COLE COMMUNITY CHURCH YOUTH MINISTRY VOLUNTEER APPLICATION

Church History and Prior Work with Children

Do you regularly attend Cole Community Church? Yes No
How long have you attended Cole Community Church? Years ________
Months_______

List all churches (including Cole Community Church) that you have attended during
the past five years:

Church Name Pastors Name Years Attended Phone

List all previous church work involving children, youth or adults (please list
each churchs name
and address, the type of work performed, supervising pastor/lay person and
dates of service):
List all previous non-church work involving children, youth or adults (list each
organizations
name and address, type of work performed, supervisors name and dates of
service):
List any gifts, callings, training, education, or other factors that have
prepared you for ministry:
COLE COMMUNITY CHURCH YOUTH MINISTRY VOLUNTEER APPLICATION

Legal Information

Yes No Have you ever either pled guilty or no contest to, or

been found guilty of, any misdemeanor, other than a speeding or parking
violation.
Yes No Have you ever either pled guilty or no contest to, or
been found guilty of, a felony?
Yes No Have you ever neglected, abandoned, sexually abused, or
physically abused any child under the age of 18 years or ever been accused
by anyone of having done so?
Yes No Are you aware of having any traits or tendencies that could
pose any threat to children, youth, or others?
Yes No Have you ever been accused by anyone of engaging in
sexual harassment or inappropriate sexual conduct?
Yes No Have you ever been asked to leave a church or otherwise
terminate your voluntary service of any other program?
If the answer to any of the above questions is yes, please explain in detail.
Please use an additional sheet of paper if necessary.
References: List Two Personal References on the reference form from
current church members(not former employers or relatives).
COLE COMMUNITY CHURCH YOUTH MINISTRY VOLUNTEER APPLICATION
Applicants Statement
The information contained in this application is correct to the best of my
knowledge. I authorize, by my signature below, any of the churches,
organizations or reference I have listed to give you any information

(including opinions) that they may have regarding my character and fitness
for youth work. I also submit to and authorize Cole Community Church to
contact law enforcement officials to screen local and national records using
my name and all related personal data I have provided in my application.
In consideration of the receipt and evaluation of this application by Cole
Community Church, I hereby release any and all persons or organizations
providing or using the information from any and all liability for damages that
may result due to compliance or an attempt to comply with this
authorization. I waive any right that I may have to inspect any information
provided about me by any person or organization identified by me in this
application.
I understand that if there are allegations of my having committed improper
behavior, I will be required to step down from my responsibilities until such
time as the Board of Elders allows me to resume those responsibilities, even
if I contend I did not behave improperly.
Should my application be accepted, I agree to abide by the policies of Cole
Community Church and to refrain from unscriptural and illegal conduct in the
performance of my services on behalf of the church.
I have carefully read and agree to abide by the Child Interaction policy of
Cole Community
Church and to protect the health and safety of the youth at all times.
I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE

CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE

ACT.
This is a legally binding agreement, which I have read and understand.
Applicants Signature Date Applicants Name (Please print)
Witness Signature Date Witness Name (Please print)
Got this from: http://www.colecommunity.org/wpcontent/uploads/2014/03/Youth-Ministry-Volunteer-Application.pdf

Safety Policies
1. No child/youth will ever be left unattended during ministry programming or classes. Staff
members or volunteers are prohibited from being alone with an individual child/youth in
any room or building. In the event a staff member or volunteer finds himself/herself alone
with a single child/youth, that staff member or volunteer will take the child/youth to a
room or building occupied by others, or to a location easilyobserved by others.
2. After every programming event, staff members and volunteers must
ensure every room and restroom is checked prior to leaving.
Off-Site Event

YOUTH CHURCH ACTIVITY WAIVER

The undersigned parent/legal guardian hereby gives permission to

___________________________ Church, for my child (insert childs name)
________________________________ to take part in the following
activity______________________________________.
Should my child require immediate or emergency medical care while engaged in an activity
sponsored by the Church, in my absence, I hereby grant the Church authority to release my
child for medical treatment to such medical personnel as the Church determines appropriate
under the circumstances.
In consideration for the privilege of allowing my child to participate in the abovenamed activity, I agree to release and hold harmless the Church, its officers and

agents, from any liability to or responsibility for bodily injury, damage or illness
to the above-identified child while participating in any youth athletic or social
activity which may be directly or indirectly sponsored by the Church. Further, I
agree to indemnify and hold harmless the Church, its officers and agents with
respect to any claim asserted by or on behalf of my child as a result of bodily
injury, illness, or damage.
Child (ren)s Allergies:

PLEASE READ CAREFULLY, THIS PERMISSION SLIP IS A LEGAL DOCUMENT

Signature of Parent or
WHICH INCLUDES A
RELEASE OF LIAIBLITY Legal Guardian
AND
INDEMNIFICATION
Date
Telephone number(s):
Home:
Work:

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Referenced from:
http://www.morrowinsurancegroup.com/img/~www.morrowinsurancegroup.com/youth
%20church%20activity%20waiver.pdf