Kids Volunteer Application

Your name *

Last name

Email address *

Phone number *

Phone type

Address *

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Birthdate

INTERESTED IN *

Nursery

Pre-K

K-5

Middle School

High School

Check in Station

Setup

Teardown

Special Events

GATHERING AVAILABILITY *

8:15

10:00

11:45

Undecided

WHAT WEEKS ARE YOU AVAILABLE? *

1st

2nd

3rd

4th

5th

Undecided

CHURCH BACKGROUND *

BRIEFLY DESCRIBE YOUR SALVATION STORY

HOW LONG HAVE YOU ATTENDED EKKLESIA? *

ARE YOU CURRENTLY SERVING IN A DIFFERENT MINISTRY OF EKKLESIA?

HAVE YOU HAD AN OPPORTUNITY TO WORK WITH CHILDREN BEFORE, EITHER AS A VOLUNTEER OR AN EMPLOYEE? IF SO, IN WHAT CAPACITY AND FOR HOW LONG? *

HAS GOD BLESSED YOU WITH ANY UNIQUE SKILLS OR EXPERIENCES RELATED TO KIDS MINISTRY? *

ARE YOU ABLE TO WORK AS A TEAM AND FOLLOW DIRECTION? *

IS THERE ANYTHING THAT INTIMIDATES YOU ABOUT WORKING WITH CHILDREN OR IN A CLASSROOM SETTING? IF SO, WHAT? *

Please list the names and phone numbers of any churches you have attended regularly during the past five years beginning with Ekklesia (please include the name of a pastor who knows you). *

THE FOLLOWING QUESTIONS ARE ASKED IN ORDER TO INSURE A SAFE AND PROTECTED ENVIRONMENT FOR THE CHILDREN WHO COME TO OUR CHURCH. PLEASE UNDERSTAND THAT THESE ARE ASKED OF EVERY VOLUNTEER

HAVE YOU EVER BEEN CONVICTED OF A SEX-RELATED CRIME? *

YES

IF YES, DID THE CRIME INVOLVE THE FORCE OF A MINOR?

YES

HAVE YOU EVER BEEN CONVICTED OF A CRIME INVOLVING THE WELFARE, SAFETY, OR VICTIMIZATION OF A MINOR? *

YES

HAVE YOU HAVE EVER BEEN ARRESTED FOR A CRIME FOR WHICH THERE HAS NOT YET BEEN AN ACQUITTAL OR DISMISSAL? *

YES

CRIMINAL HISTORY AUTHORIZATION

By my signature below, I hereby authorize Oregon State Police to release any information, which pertains to any record of conviction, in its files or in any criminal file maintained on me whether local, state or national. I hereby release OSP and Ekklesia from any liability resulting from such a disclosure.

I understand that I may obtain a copy of the Criminal History Report and will be given the opportunity to challenge the accuracy and completeness of this report and obtain a prompt determination as to the validity of the challenge before a final determination is made by Ekklesia. (Type your name in place of a signature.)

YOUR NAME (AS SIGNATURE) *

References

Please list 3 references outside of your family who know you well and would recommend you for ministry with children (at least one reference must attend Ekklesia who is not a Pastor).

NAME *

ATTENDS EKKLESIA? *

RELATIONSHIP *

PHONE *

EMAIL *

REFERENCE WAIVER AND INTERVIEW AGREEMENT

By my signature I certify that all of the information is true to the best of my knowledge and I waive the right to inspect references and the right to hold the church liable for damages that may result from such evaluations. I also understand that I cannot serve anywhere in the Ekklesia Kids without approval of the Ekklesia Pastors and Elders and that this approval will require a background check with the State of Oregon. (Type your name in place of a signature.)

YOUR NAME (AS SIGNATURE) *

Ekklesia Eugene
info@ekklesiaeugene.org
5419129411