Volunteer with Children and Youth Application Form

This information form is used to help State College Presbyterian Church (SCPC) provide a safe and secure environment for its children and youth, as well as leaders who participate in its programs and use its facilities. Before undertaking any position involving the supervision of children or youth, individuals will complete this form, plan to attend the next available Safe Church training (held in Fall usually), and have the required clearances (listed on page 3). To be considered as a volunteer working with children or youth, a person must be actively attending State College Presbyterian Church for at least 6 months. The information obtained from this form is for the use of State College Presbyterian Church only. Those applying to be LIT’s (Leaders In Training) also need to have parents sign this form in the parental consent portion. LIT is the term we use for youth who would like to volunteer their time and energy with our children/youth. LIT’s need to be at least 3 years older than the oldest child/youth they are volunteering with.

Applicant’s Name

Address

Home and cell phone numbers

Current Employer

Date of Birth

Please list the areas in which you would like to volunteer at SCPC (or which you already agreed):

List any health-related training and certifications (CPR, first aid, lifeguard, EMT, etc.)

If you have been active at SCPC LESS than 2 years, please list two references who are not family members, and are not already a part of this congregation:

Reference Name:

Phone:

Email (if known):

Reference Name:

Phone:

Email (if known):

In caring for children and youth, we believe it is our responsibility to seek adult volunteer staff that is able to provide healthy, safe, and nurturing relationships. Please answer the following question accordingly. Answering yes to the question will not automatically disqualify a person from volunteering in our church. Any special concerns can be discussed individually with the pastoral staff.

Have you even been convicted of or pled guilty to a crime, either misdemeanor of a felony (including but not limited to drug-related charges, child abuse, other crimes of violence, theft or motor vehicle violations?)

Yes No

If yes, please explain:

Parental Consent for applicants age 17 and younger:

I give permission for my child to volunteer at SCPC, and to participate in the LIT program with our Sunday morning, LOGOS GECKOS and/or Chrysalis program.

Parent’s printed name:

For those interested in being drivers:

I am willing to drive youth to/from events during the course of the program year if the dates work with my schedule, and I have a legal license to drive. (Drivers must be 25 years of age)

To be completed by ALL:

Applicant’s statement: The information provided in this application is correct and complete to the best of my knowledge. I authorize SCPC to contact the references provided. I agree to follow the policies set forth in the Safe Church training/handbook that I will receive at a training event. I understand that any violation of this policy may result in the termination of my volunteer service.

Applicant’s Printed Name:

Date:

Volunteer with Children and Youth Application Form

Parental Consent for applicants age 17 and younger:

For those interested in being drivers:

To be completed by ALL:

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