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Confidential Application for Ministry with Minors or Special Needs Adults

Your name *

Last name

Email address *

Address *

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Phone number *

Phone type

Background Information

Have you personally accepted Jesus Christ as your Lord and Savior and are you committed to having the character of Jesus live through you? *

Yes

Do you regularly attend a small group or Bible study? *

Yes

I'd love to start!

Do you regularly attend our worship services? *

Yes

Have you been involved in ministry before at any other churches (or ministries)? What kind of ministry did you do & what church (city/state) was it in? *

Personal Situations

Marital status *

Do you have children of your own? *

Yes

Have you ever been arrested, convicted or pleaded guilty to a crime? *

(if yes, we will ask to speak with you)

Yes

Have you ever been accused, charged or aleged to have, or have you ever committed any act of neglecting, abusing or molesting any child, youth or special needs adult? *

(if yes, we will ask to speak with you)

Yes

Gender *

Birthdate *

Grade

I have download and read the River Shores Child Protection Policy. *

Authorization and Acknowledgement *

By checking the box above, that legally constitutes my signature, and I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by River Shores Church, Inc at any time after receipt of this authorization and throughout the course of my employment or volunteering, if applicable.

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River Shores
rivershoreschurch@gmail.com
920.376.5877

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