Volunteer Application

If you are interested in volunteering with kid city OR AS A SUMMER YOUTH LEADER Please complete the form below

Name

First Name

Last Name

Email

Phone

(###)

###

####

Birthdate

MM

DD

YYYY

Gender

Which congregation are you interested in volunteering with?

Personal History

In order to ensure the health, safety, and security of our children, we reserve the right to screen our volunteers. Please check the appropriate answers below so we may discuss how this may impact your serving in Kid City.

Health Problems

Do you have any health problems (disabilities, physical limitations, etc.) that might affect your work with children?

Yes

No

Addictions

Have you ever had a problem with drugs, alcohol, pornography, or any other addiction, or, has anyone ever suggested that you may have a problem with any of these things?

Yes

No

Arrest Record

Do you have an arrest record?

Yes

No

If "yes" to any of the above 3 questions, please explain further:

Child Abuse

Have you ever been convicted or accused of physical abuse, sexual abuse, neglect, molestation, or exploitation of a minor?

Yes

No

Authenticity, Authorization, and Background Check

I authorize Holy Trinity Church or its representatives to make any and all appropriate inquiries regarding my background, and I release the church and its representatives from any liability which may result from such actions. I understand that if I type my name in the spaces below this is a legally binding equivalent of a traditional handwritten signature. The information included in this profile is correct to the best of my knowledge.

SSN

Social Security Number is required for background check.

Signature:

Date:

MM

DD

YYYY