Application Youth Leader












4.1. APPENDIX A.
Application to Serve in Children’s / Youth Ministry
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Dear Prospective Volunteer, as a church community we have an obligation before the Lord and the Laws of our country to do all in our power to provide a safe environment for children and young people who participate in our Children's /Youth ministries
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Session (Church Council) requires every person, whether paid or a volunteer, to hold a “Blue Card” and complete this form.
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Once you have completed the form, you must have your signature witnessed by the Minister or and Elder of Session. If you have difficulty filling in this form, please seek the help of the Minister.
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Please Note. Understanding that personal details are contained within this application, the information will be held only by the Minister/Youth Elder of the church.
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Do you hold a CURRENT “Blue Card”? No / YES Registration Number


Your Surname:


Christian Name(s):


Present Address:


Home Phone:


Mobile Phone:


Normal Occupation:


Date of Birth:


Marital Status: Single / Engaged / Married / Separated / Divorced / Remarried / Widowed


1. Briefly outline why you would like to be involved in this position:


2. List any gifts, calling, training, education or other factors that you believe have prepared you to serve in this role:


3. Do you have any disabilities or conditions that might prevent you from performing certain types of activity relating to this position? Yes / No


If yes, please explain:


4. Have you ever had a problem in the area of controlling your feelings or behaviour towards minors (people under the age of 18)? Yes / No


If yes, please explain:


5. Have you ever been accused, charged or convicted of child abuse, or a crime involving actual or attempted sexual molestation of a minor? Yes / No


If yes, please provide details:


6. Is there any other relevant information relating to child abuse or any other matter pertaining to yourself, that Mansfield Christian Reformed Church should know about in order to determine your suitability for the position?


7. (Fill this in only if you have been a member of this church for less than 5 years) List the name and address and phone number of the churches you were regularly attending in the previous 5 years (if any):


List all the previous church work and or non church involvement you had with children/youth work in the past 5 years (if any): Church / Organisation; Type of involvement; Dates; Contact Person; Phone

8. Applicant's Statement: The information contained in this application is true to the best of my knowledge
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I authorise any persons, churches or organisations listed in this application to give the Minister (or other person designated by church council) of MCRC any information they may have regarding my character and fitness for children's /youth work
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I also give consent for Mansfield CRC to obtain information about any criminal/traffic record pertaining to me that the police may hold.
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Should my application be accepted, I agree to perform my services on behalf of Mansfield CRC in a manner consistent with Biblical teaching, and any protocols issued to me from time to time.
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I undertake to immediately advise the Minister (or in his absence one of the Elders) of any change in the information provided by me in this application, or any other information, relevant to my suitability.
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Print your name


Parent's/Guardian's Signature (if applicant is under 18 yrs of age)


Declared before me: Name, Position, Address, At, Date


Signed (by the witness)

Thank you for completing this form. Please return it to the Minister (press "Submit" button). Please contact Minister for necessary signatures.
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