Phone Number *
Phone type Mobile Home Work Other
Which site do you attend? *
Select… Evening Oakridge Mount Pleasant East Van West Side UBC Summer Camp Volunteer
Which age group interests you? *
Please share a bit about your faith journey. *
Have you worked with kids before? Explain. *
Tell us about the last church you attended.
Include: Church Name, Phone Number, Address, City and Dates Attended (Month and Year)
What concerns you about working with children?
List any interests, skills, training or spiritual gifts.
List any volunteer experiences that would be relevant
Include: Name of Organization, Your Role/Responsibilities, and Dates of Service.
Relationship to Applicant and Years Known *
Relationship to Applicant and Years Known *
1. Are there any circumstances involving your lifestyle or history that could call into question your ability to work safely with children or youth in a Christian environment? (e.g. use of pornography, use of illegal substances, etc.) *
Select… Yes No I am under 18
2. a) Have you ever been convicted or found guilty of a criminal for which a pardon has not been granted? (Note: this does not include minor traffic violations) *
Select… Yes No I am under 18
2. b) If yes, please list offence(s) and the date(s) of conviction
3. Have you ever been expelled from or had your employment terminated any organization or employer for assault or violence against any person, or for assault, violence or impropriety with children, youth or vulnerable persons? *
Select… Yes No I am under 18
4. Have you ever been investigated by the BC Ministry of Children and Development or any other organization for suspected child abuse? *
Select… Yes No I am under 18
5. Do you have any health concerns which could impact your ability to perform the functions of the volunteer position for which you are applying? *
Select… Yes No I am under 18
6. Do you have any contagious diseases or medical conditions of we should be aware, and of which we may need to take steps to protect against transmission should you volunteer at the church? *
Select… Yes No I am under 18
Release of Information and Declaration of Intent (Sign Your Full Name) *
1. In order to decide my suitability for volunteer ministry in this organization, I hereby give the designated leadership of Tenth Church consent to: • Verify the information provided by me in this Volunteer Application Form • Contact the references and employers listed in this application • Obtain and verify any information from them and any other persons that the church determines to be relevant to my application 2. I understand that in British Columbia a Criminal Record Check is legally required for anyone working with the Vulnerable Sector (children, youth and vulnerable adults). I therefore agree to complete a CRC and have it returned to Tenth Church as soon as possible. 3. I further grant Tenth Church permission to perform an internet search on me and to review and consider any information found posted by me on the Internet. 4. I understand that if Tenth Church approves my volunteer application and later determines, in its discretion, at any time that I am not suitable for volunteer service in Tenth Church or for the volunteer position for which I am applying, the leadership may terminate my volunteer service or volunteer position for any reason without advance notice. 5. If Tenth Church approves my application for a volunteer position, I will sign any documents that the church requires and will at all times cooperate fully with the church leadership in the fulfillment of my duties and will keep all confidential information I encounter in my role as a volunteer, confidential. 6. If at any time I determine that for any reason I am unable to support or adhere to or follow the policies, procedures or doctrine of Tenth Church, I will inform the church leadership and will resign my volunteer position. Information received in this Tenth Kids Application Form is confidential and is being gathered for the purposes of considering your application for volunteer ministry with Tenth Church and for assessing potential ministry opportunities for you in the future. The information you provide here will be used for Tenth’s ministry purposes only and so will be shared with necessary people/parties. By signing, you are indicating your agreement with this use. I hereby acknowledge that, to the best of my knowledge, the information contained in this Tenth Kids Application Form is true and correct. Sign your full name to indicate that you agree to the terms.
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