KidCity Adult Volunteer Application

* First Name

* Middle name

* Last Name

* Gender

* Birth Date

* Address

Address 2 (Apt/Suite # etc.)

* City

* State/Province

* Zip/Postal Code

* How long have you lived at this address?

Previous address

* Email

* Mobile Phone

* Preferred Contact Method

* Marital Status

What is your spouse's name?

* Number of Children and Ages

* Emergency Contact (other than spouse)

* Emergency Phone

* Are you currently First Aid and CPR certified?

* T-shirt size (Adult)

* Have you made a personal decision to receive Jesus as your Lord and Savior?

* Would you feel comfortable talking to a child about salvation and leading him/her to Jesus?

* When and how did you come to know Jesus? What has your journey with Jesus been like?

* How long have you attended Pathway?

* List all leadership/volunteer experience you have had with children

Personal Reference(s)

* Please list the name of someone who knows your character well. They must be 18 or older and not related to you.

* Personal Reference Phone Number (including area code)

* Personal Reference Email Address

* Personal Reference Street Address

* Personal Reference City

* Personal Reference State

* Personal Reference Zip Code

* Second Personal Reference

* Second Personal Reference Address

* Second Personal Reference Email Address

* Second Personal Reference Phone (with area code)

* Are you currently struggling with an addiction to drugs, alcohol, pornography or any other addiction? If yes, please explain

* Have you in your past ever struggled with an addiciton to drugs, alcohol, pornography or any other addiction? If yes, please explain

* Has anyone ever suggested to you that you may have an addiction to drugs, alcohol, pornography, or any other addiction? If yes, please explain

* Have you ever been arrested, convicted, or pleaded guilty to a crime more serious than a traffic violation? If yes, please explain

* Have you ever been accused of, charged with, alleged to have or have you ever committed an act of neglecting, abusing, molesting or battering any child or adult? Or have you had any kind of relationship with a minor that has brought you sexual gratification? If yes, please explain

* Have you ever been accused or convicted of possession and/or sale of controlled substances or of driving under the influence of alcohol or drugs? If yes, please explain

* Do you use illegal drugs? If yes, please explain

* Have you ever gone through treatment for alcohol or drug abuse? If yes, please explain

* Have you ever been or are you currently being treated for a psychiatric disorder?

* If yes, what type of treatment did you receive or are you currently receiving?

* Are you currently in a relationship with someone AND living together outside of marriage? If yes, please explain

* Is there any circumstance or pattern in your life which would make it inappropriate for you to serve with minors or would compromise the integrity of Pathway Community Church? If yes, please explain

* Have you ever been asked to step away from ministry or been asked to step down from working with students or children in any setting, paid or volunteer? If yes, please explain

PLEASE READ THE FOLLOWING CAREFULLY AND INDICATE YOUR CONSENT TO EACH ITEM BY TYPING YOUR INITIALS IN THE BOX PROVIDED

- KidCity Volunteer Questionnaire

* The information contained in this application is correct to the best of my knowledge. I authorize any references listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for work with children or youth. Initials:

* I authorize the release of the information contained in this application on a confidential, need to know basis, to any Ministry at Pathway Community Church in which I seek a position. Initials:

* I hereby release any individual, church, youth organization, charity, reference or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or family, on account of compliance or attempts to comply with this authorization. Initials:

* To uphold the confidentiality of the references, I waive any right that I may have to inspect any information provided about me by any person or organization, but I may contact Pathway Community Church to inquire about information provided about me. Initials:

* Should my application be accepted, I agree to refrain from unscriptural conduct in the performance of my services on behalf of the Church. I agree to be bound by the bylaws, statement of faith and policies of Pathway Community Church. If I violate these guidelines, I understand that I have disqualified byself from any volunteer opportunities. Initials:

* I understand the expectations that Pathway Community Church and KidCity have of me as an Adult Volunteer and I am committed to doing my best to fulfill these expectations.

* By signing this application, I state that all of the information given about myself is true. I further state that I have carefully read the foregoing release and know the contents thereof and sign this release as my own free act. This is a legally binding agreement, which I have read and understand. Full name and date:

* By signing below, I give my consent to allow KidCity to use my likeness in printed and online materials. Full name and date:

Personal Reference(s)

PLEASE READ THE FOLLOWING CAREFULLY AND INDICATE YOUR CONSENT TO EACH ITEM BY TYPING YOUR INITIALS IN THE BOX PROVIDED

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