VOLUNTEER: KID'S MINISTRY APPLICATION

Address *

Phone number *

Birthdate *

What campus do you attend *

How long have you attended RVC *

If you have ever been arrested, explain below *

Type NA in not applicable

Is there any reason why you would pose a risk to children and/or ever participated in, been accused or convicted of, or plead guilty or no contest to any abuse or sexual misconduct, if yes explain below *

Type NA in not applicable

Do you have any physical handicaps or conditions preventing you from performing certain types of activities, if yes explain below *

Type NA in not applicable

REFERENCES

#1 Reference: First and Last Name *

#1 Reference: Phone Number *

#1 Reference: Relationship to You *

#2 Reference: First and Last Name *

#2 Reference: Phone Number *

#2 Reference: Relationship to You *

VOLUNTEER INFORMATION

Ministry Choices *

Pick all that apply

Birth-2 years

2-4 years

K-3rd grade

4 & 5th grade

Special Needs Buddy

Which campus do you want to serve at *

How often would you like to help *

List all service time(s) that you want to serve at *

Why would you like to serve in this ministry *

List of previous volunteer work *

Please give a brief testimony of your salvation experience (include when you were saved and your spiritual growth since that time) *

EMERGENCY CONTACT

Emergency Contact First and Last Name *

Emergency Contact Phone Number *

Medical Insurance Company Name *

Medical Insurance Policy Number *

Signature for Medical Treatment of a Minor: I hereby give my consent for River Valley Church to secure emergency medical treatment by a licensed physician or dentist in the event I cannot be reached *

Type your full name. Type N/A if not applicable

Date signed *

Type your name if you agree: I understand that a criminal background check will be conducted for all applicants *

Date signed *

My authorization *

By typing my name below, I do hereby affirm that I have read, understand and consent to all these statements. I further authorize that a photographic copy or a telephonic facsimile of this document shall be valid for purposes present and future. My signature certifies that all information I have provided in connection with this background check is true, accurate and complete to the best of my knowledge.

Date signed *