Name*

First Middle Last Suffix

Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Home Phone

Email*

Birth Date*

Please list any past experience you have working with children/youth, including name and place of the institution(s) and organization(s).*

Please provide names, addresses, phone numbers, and email addresses for two non-relatives who are familiar with your character as it relates to working with children and youth.

Reference #1 Name*

First Last

Reference #1 Address*

Street Address Address Line 2 City State ZIP Code

Reference #1 Phone*

Reference #1 Email*

Reference #2 Name*

First Last

Reference #2 Address*

Street Address Address Line 2 City State ZIP Code

Reference #2 Phone*

Reference #2 Email*

Are you currently under investigation for a crime involving children or youth?*

Yes
No

Have you ever been convicted of, or pled guilty or no contest to any crime after having been accused of any incident involving children or youth?*

Yes
No

Have you ever been found responsible or guilty in any court for neglect or abuse of a child?*

Yes
No

I agree to the following:*

(1) I agree to observe all church policies. (2) I have read and understand and agree to abide by the Children & Youth Safety Policy of Ladue Chapel Presbyterian Church.

I agree

By signing this form, I agree to an annual background check and I agree to notify the church of any changes to my information.

I agree

Electronic Signature*

Date

Forms & Policies

For Members - Children & Youth Volunteer Information Form

For Non-Members - Children & Youth Volunteer Application

Volunteer Driver Form

CHILDREN

YOUTH

IMPORTANT TIMES

COME AND SEE

Check out upcoming ways to join us: