KidCity HS Student Volunteer Application

* Student First Name

* Student Last Name

* Student Gender

* Student Birth Date

* Student Grade in High School

* Student Address

Student Address 2 (Apt/Suite # etc.)

* Student City

* Student State/Province

* Student Zip/Postal Code

* Student Email

* Student Home Phone

* Student Mobile Phone

* Preferred Contact Method

* Student Emergency Contact

* Student Emergency Phone

* T-shirt size (Adult)

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

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

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

* 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 Email Address

Personal Reference Street Address

Personal Reference City

Personal Reference State

Personal Reference Zip Code

* Personal Reference Phone Number (including area code)

* Why do you desire to volunteer in KidCity

* 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

* Are you using illegal drugs?

* 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?

* Has there been any abuse in your family background with drugs or alcohol or that was emotional, physical or sexual in nature? If yes, what steps have you taken to minimize the impact that those issues will create for you?

* 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

* All youth volunteers must have a youth covenant on file and have a name badge before being permitted to serve. I understand that I cannot bring a friend who is not screened to serve in KidCity

* 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:

* 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:

* 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)

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