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Men
Kids Hope USA Volunteer Application
Please take some time to fill out this form completely.
First Name
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Middle Initial
Last Name
*
Phone
*
Cell Phone
Address
*
Email
List all other names by which you have been known.
Date of Birth
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Diver's License #
Length of membership/attendance at church
T-Shirt Size
*
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Small
Medium
Large
XLarge
2X
3X
Emergency Contact Name
*
Emergency Contact Relationship
*
Emergency Contact Phone #
*
Please Indicate for what role you would like to volunteer:
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Regular Mentor
Substitute Mentor
Prayer Partner
Occasional Special Projects
Please list previous volunteer activities
*
Volunteer Pledge
If I am assigned as a school volunteer, I accept the responsibility to serve in support of the educational program and supplement the work of the professional staff, under their guidance. I understand that it is important to be reliable, channel suggestions constructively, keep information confidential, and comply with school rules. As a member or regular attender of this Church, I agree to be accountable to the leadership of this church regarding my Christian life and witness according to the biblical witness of this church and in all aspects of conduct and performance related to this volunteer position.
I understand that a very positive benefit, when working with students, is the relationship developed between the volunteer and student. I take seriously the relationship that will be formed. I agree to a criminal history check (national and/or state level). My signature on this form authorizes you to make such checks and to disclose results to both church and school personnel as part of the KIDS HOPE USA program.
Date
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I accept and agree to the Volunteer Pledge
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Y
es
N
o
Central Wesleyan Church Volunteer Police Check Information
In light of the society we live in, we as a church are seeking to do all we can to protect the young people that we minister to in every way possible. This volunteer police check enables us to maintain the highest possible standards of integrity in our relationships with parents, volunteers, school administrators and others from the community who we reach out to with God's love. Your signature attests that you have not committed any criminal sexual offenses and authorizes the screening process. Please be assured that all records are kept confidential and that only sexual charges or felony convictions are seen as possible disqualification for ministry. Thank you for all the ways that you help us reach Holland and beyond for the glory of God. Your impact as a volunteer is highly valued.
I accept and agree to the Volunteer Police Check
*
Y
es
N
o
Full Legal Name
*
Ethnicity
*
Gender
*
M
ale
F
emale
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