Today's Date *

MM

DD

YYYY

Cell Phone *

(###)

###

####

Daytime Phone

(###)

###

####

Home Phone

(###)

###

####

If you have lived at your current address less than seven years, provide information on all addresses during that period. (Needed for Criminal History Check)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birth Date *

MM

DD

YYYY

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Reference #1 Name *

First Name

Last Name

Reference #1 Phone *

(###)

###

####

Reference #2 Name *

First Name

Last Name

Reference #2 Phone

(###)

###

####

Reference #3 Family Name *

This should be a family relative.

First Name

Last Name

Reference #3 Family Phone *

(###)

###

####

Suggested Prayer Partner name

First Name

Last Name

Suggested Prayer Partner Phone

(###)

###

####

Volunteer Pledge *

If I am assigned as a school volunteer, I accept the responsibility to serve in support of the educational program and supplement the work of the professional staff, under their guidance. I understand that it is important to be reliable, channel suggestions constructively, keep information confidential, and comply with school rules. As a member or regular attendee of this church, I agree to be accountable to the leadership of this church regarding my Christian life and witness according to the biblical witness of this Church and in all aspects of conduct and performance related to this volunteer position. I hereby represent and warrant that the information contained in this application is correct and complete to the best of my knowledge. I authorize any references, or any other person or organization, whether or not identified in this application, to give you any information (including opinions) regarding my character and fitness for volunteer service. I understand that a very positive benefit, when working with students, is the relationship developed between the volunteer and student. I take seriously the relationship that will be formed. I agree to a criminal history check (national and/or state level). My initials on this form authorizes you to make such checks and to disclose results to both Church and School personnel as part of the KIDS HOPE USA program. By pressing “submit” on this form I am agreeing to these terms and I am agreeing that the information is provided by the applicant on this form.

Agree

Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Day of the week? *

What day is best to schedule an interview?

Monday

Tuesday

Wednesday

Time of day? *

What time of day do you prefer?

morning

afternoon

What volunteer position are you interviewing for?

Mentor

Super Sub

Still deciding