Returning Volunteer Form — KIDS HOPE EAGLE ROCK

Kids Hope Returning Volunteer Application

Date

YYYY

Name

First Name

Last Name

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

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)

Birthdate

YYYY

Drivers License #

Are you 18 years of age or older?

List all other names by which you have ever been known

Length of membership/attendance at CA

Social Security #

Please note we need this information to complete your background check. We will note share this information without your consent.

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

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Please indicate which role you would like to volunteer

T-shirt size?

Weekly Mentor Options

Suggested Prayer Partner Name (Not Needed for Super Subs)

Suggested Prayer Partner Email

Suggested Prayer Partner Phone

(###)

###

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KIDS HOPE 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, to channel suggestions constructively, keep information confidential, and comply with school rules. I understand we are a guest on the school campus and will respect the separation of church and state while on school grounds. 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.

I have read and agree to the Kids Hope Pledge

Agree

Initials