Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

#1 Phone *

(###)

###

####

#2 Phone *

(###)

###

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Were you the victim of child abuse while a minor? *

Yes

No

Have you had any experiences that might make it difficult for you to minister to children? *

Yes

No

Have you ever been accused or convicted of a misdemeanor or felony? *

Yes

No

Do you use illegal drugs? *

Yes

No

Have you ever been treated for or struggled with alcohol or substance abuse? *

Yes

No

Have you ever been charged with child neglect or abuse? *

Yes

No

Do you have any health issues that could place children at risk? *

Yes

No

Do you object to a criminal background check? *

Yes

No

If serving in a nursery role, have you read the nursery handbook? (You can access this handbook at the top of this page).

Yes

No

I'd prefer to serve during Sunday School (9:15-10:30)

I'd prefer to serve during the worship service (10:30-12:15)

I could serve in either Sunday School or Worship Service Nursery

I'd be interested in helping on Christmas Eve or Christmas Sunday nursery

I'd be interested in helping on Easter Sunday nursery