Family Ministries Volunteer Form Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Married(Required) Yes No Spouse's Name:(Required) When did you accept Jesus as your Lord and Savior?(Required) Have you been baptized? If so, when?(Required) Briefly describe your relationship with Jesus Christ.(Required)Have you attended Intro to CF?(Required) Yes No Are you a member of Christ Fellowship(Required) Yes No In Process How long have you attended Christ Fellowship?(Required) Which area of Student Ministry are you interested in serving?(Required) Nursery Toddlers Pre-K Elementary Middle School High School What position are you interested in?(Required) Small Group Leader Small Group Assistant Storyteller/Host/Teacher Worship Team Media Team Why do you want to serve in Student Ministry?(Required)List any relevant training, experience or spiritual gifts that have equipped you to serve in Student Ministry.(Required)Church ActivityPlease list the church or churches you have attended in the past five years.Church Name:(Required) Pastor's Name:(Required) Years attended:(Required) Did you serve there?(Required) Yes No In what capacity?(Required)Church Name: Pastor's Name: Years attended: Did you serve there? Yes No In what capacity?Church Name: Pastor's Name: Years attended: Did you serve there? Yes No In what capacity?Background InformationWe value your interest in serving in Family Ministry. We consider serving with children a place of leadership in the church because of the tremendous influence volunteers have. Because of this, we ask individuals desiring to serve with children to meet specific qualifications. There is a place for everyone to serve at Christ Fellowship; however, if you participate in any of the following lifestyles, we ask that you talk to a staff member before applying to volunteer in Family Ministries.Are you living with a person you are in a romantic relationship with(Required) Yes No Are you pursuing an affair outside of marriage?(Required) Yes No Are you participating in a same-sex relationship?(Required) Yes No Are you going through a season of marital strife, divorce, or family conflict?(Required) Yes No Are you currently or have a history of engaging in illegal drugs, marijuana, or pornography?(Required) Yes No Are you currently or have a history of using alcohol or other legal substances excessively?(Required) Yes No Have you ever been accused or convicted of domestic violence, achild abuse, child molestation, or any othe sexual abuse?(Required) Yes No If you answered YES to any of the above questions, do you wish to speak with a staff member? Yes No PhoneEmail Preferred method of contact: Phone Email Either Personal ReferencesPlease list the names and contact information of two independent references who are not related to you. (Past ministry leaders or former employees preferred.)Name(Required) First Last Phone(Required)Email(Required) Name(Required) First Last Phone(Required)Email(Required) CHILDREN'S/YOUTH WORK VERIFICATION AND RELEASE(Required) I recognize that Christ Fellowship is relying on the accuracy of the information I provide on the Family Ministry Volunteer Application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct. I authorize CF to contact any person or entity listed on the Family Ministry Volunteer Application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications. I voluntarily release CF and any such person or entity listed on the Family Ministry Volunteer Application form from any liability involving the communication of information relating to my background or qualifications.Signature(Required)Date(Required) MM slash DD slash YYYY PREVENTION PRACTICES & PROCEDURES TO PROTECT CHILDREN & YOUTH(Required) I acknowledge that I have received, understand and agree to follow the Policy & Procedures for the Prevention of Sexual Misconduct of Christ Fellowship in Kingsport, TN.PREVENTION PRACTICES & PROCEDURES TO PROTECT CHILDREN & YOUTH These Prevention Practices & Procedures of Christ Fellowship deal with the prevention of sexual misconduct as well as some general safety concerns. These Prevention Practices & Procedures shall be given to each employee and to all volunteers who supervise activities for children and youth as a part of the Policy & Procedures for the Prevention of Sexual Misconduct of Christ Fellowship. (For the purpose of these Prevention Practices, "adult" means someone 18 years of age or older. Anyone below 18 years of age is considered a child or youth.) All those working with children/youth are subject to background screenings and other screening procedures including a check for a previous record of Driving While Intoxicated or any reckless citation. o At least two adults will be present during all child/youth activities. Travel off church premises: o At least two screened and unrelated adults must be present at every function and in each classroom, vehicle, or other enclosed area during all activities involving children, youth or vulnerable adults. Exception: When the Two Adult Rule cannot be supported the Rule of Three should be applied. The goal being that no one adult should ever be alone with one child or youth. At least three individuals defined as: one screened adult and two youth. o Permission slips with details are required for all trips off church premises. o When a church program or activity calls for someone to drive children/youth anywhere, be sure to have on file a form which records important information about the vehicle operator and the vehicle to be used. Fill out the form copy of the driver's license and the Proof of Insurance. Pick up after youth events: o If children/youth are to be picked up by someone other than a parent or known babysitter or dropped off somewhere other than his or her home, the parent(s) or guardian should indicate that person's name and phone number. Children/youth will be released to properly identified and authorized adults only. o An adult leader should stay with children/youth at the conclusion of an activity until every child/youth has been picked up. Never leave a child/youth alone waiting for a ride home. Overnight events: o Parents and/or staff must approve overnight stays in advance. o For overnights (lock-ins, camp, etc.) always have at least 4 adults present (and more if the size of the group requires), including 2 males and 2 females. o Make parents/guardians and children/youth aware of the ground rules which will govern all such overnight events. Be clear about specifying the consequences of any infraction. o For overnights, whether on church property or elsewhere, be sure that separate sleeping areas are provided for boys and girls and that privacy is assured for use of bathroom facilities and for changing clothes. o If a child/youth needs to undress (for example, to get into a costume or for first aid), do call another adult to accompany you. Be sure that separate dressing areas are provided for boys and girls and that privacy is assured. o We have an "open door policy" that is, church staff and adult youth leaders always have the right to visit and observe a class or program at any time unannounced. Classroom doors should never be locked with children inside. If the door is locked, the half-door should be left open. Where feasible, put glass in the doors so someone can always see in the classroom. o Even playfully, even if a child or youth asks, do not touch any part of the body that would be covered by a modest swimsuit, nor on the clothing, which covers those parts. o Never meet a child/youth in secret or in an unplanned way without discussing the meeting with parents and/or appropriate supervising people. Also, do not become involved in secret “meetings” with a child/youth by computer instant messaging, e-mail or in a chat room. o It is unwise to be alone (and out of sight of anyone else) with a child/youth. If that seems necessary, ask another adult to stand by or alert your supervisor that the private conference took place. o If you have an encounter with a child/youth where you think there might be a possibility of misunderstanding or misinterpreting your behavior, alert the Executive Pastor. Document with a dated memo. Where possible, discuss the matter with the child's parent or guardian. o Use caution about any movies or videotapes, which might raise concerns. Offer to show them to parents first (even if parents do not take up your offer). Videos should be age appropriate; the supervisor must clear anything over a PG rating. o Use caution about choosing video games for students. Only allow access to E or T games. Under no circumstance should M games be played. o Never show youth any material that displays nudity or could by any standard be called obscene or pornographic. If a youth or anyone brings such material, confiscate it at once and consult with supervisor/staff. o Alcoholic beverages, illegal drugs, or tobacco products are never permitted to be brought to or consumed during any church-related activity for children/youth. o If a child/youth comes to any church program and appears intoxicated (from either drugs or alcohol), contact parents immediately and consult with the Executive Pastor or other authority for further action. Acknowledgement of Sexual Misconduct Policy Sexual misconduct is strictly prohibited and will be cause for termination of the employee or volunteer of Christ Fellowship who is guilty of such misconduct. Sexual misconduct includes any form of sexually inappropriate behavior or contact, whether criminal or not, by employees or representatives of the Church, whether staff or volunteer, whether paid or unpaid, and without regard to particular titles of positions. Anyone who knows or suspects sexual misconduct shall immediately report the incident or suspicion to the Lead Pastor or Executive Pastor. If the misconduct involves sexual offense or abuse against a child, it should be reported also to the local law enforcement authorities in conformity with applicable laws. Christ Fellowship strictly prohibits interaction with children and youth by anyone with a civil or criminal record of sexual offense against a child or anyone who has admitted to committing prior sexual abuse. Anyone who knows of or suspects sexual offense or abuse against a child shall immediately report the incident or suspicion to the Lead Pastor or Executive Pastor. The suspected offense or abuse should be reported also to the local law enforcement authorities in conformity with applicable laws.Signature(Required)Date(Required) MM slash DD slash YYYY BACKGROUND CHECK PERMISSION(Required) The information contained in this application is correct to the best of my knowledge. I hereby authorize Christ Fellowship and its designated agents and representatives to conduct a comprehensive review of my background causing an investigative report to be generated for employment and/or volunteer purposes. I understand the scope of the investigative report may include but is not limited to the following areas: verification of social security number, current and previous residences, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions, driving records, and any other public records. I further authorize any individual company, firm, corporation, or public agency (including Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Christ Fellowship or its agents. I further authorize the complete release of any records or data pertaining to me which the individual company, firm, corporation, or public agency may have, to include information or data received from other sources. Christ Fellowship and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant’s personal information, including but not limited to, addresses, social security numbers, and dates of birth.To protect your personal information, we will send you an email from a third-party representative requesting a personal background check. We do not keep your personal information on file. *Please note that the safety of our kids and members are our top priority; it is mandatory that our student ministry volunteers receive a background check.Signature(Required)Date(Required) MM slash DD slash YYYY
