Serving

Child Safety Application

Every person working with children or youth must go through an orientation meeting where our Child Safety Policy is reviewed. Every person working with Children or Youth must agree to abide by our policy. This process is being used to help the church provide a safe and secure environment for the children and youth who participate in our programs and use our facilities

Name*
First Last
Address*
Street Address Address Line 2 City Email Address ZIP / Postal Code
Phone*
Social Security #*

Required for a background check
Drivers license # and State*

Required for background check
Church presently attending*

Please give us the name of the church you are presently attending and the pastors name & phone
1. Are you comfortable leading a child to Christ?"*
2. What are your gifts & experiences as they relate to children’s work?"*
3. Do you have any questions about how to deal with children?”*
4. Have you ever been convicted of or pleaded guilty to a crime? Please Explain*
5. Have you ever been involved in, convicted of or charged with any kind of child abuse?*
6. Have you read our policies regarding work with children?*
7. Do you understand and agree with our policies regarding children's work?*
8. What kind of work would you like to do in our Awana Club*
- Sparkies Teacher – Large Group Time
- Sparkies Leader – Small Group Time
- T&T Teacher – Large Group Time
- T&T Leader – Small Group Time
- Game Leader
Consent & Digitial Signature*
I agree to the policy and background check
I have read and understood the Child Safety Guidelines, Discipline Procedures, Safe and Secure Policy and this Application. The information I have provided is correct to the best of my knowledge. Should my application be accepted, I agree to be bound by the Constitution and policies of Pine Grove Community Church and to refrain from unscriptural conduct in the performance of my services on behalf of the church.

I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children or youth work. I release any individual, church or any other person or organization, from any and all liability for damages on account of compliance with this authorization. I authorize the Department of State Police to conduct a criminal history check if necessary, and to furnish a response to Pine Grove Community Church..
Please Type your Name Here if you consent to the policy*

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Serving

Child Safety Application

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