Adventurer Volunteer Data Sheet

Ohio Conference: Adventurer Volunteer Data Sheet
Section I: Personal Record

Section 1 of 8
Full Name

First NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Drivers License No.
E-mail
Church
Adventurer Club
Marital Status

SingleDivorcedMarried
Name of Spouse
Have you ever been an Adventurer? Where and when?
Will you be driving Adventurers to various events? If yes, please complete Volunteer Driver Questionnaire.

YesNo

Section II: Health History

Section 2 of 8
List any injury/disability/health factor that might limit your involvement in ministry activities, or impact the health of children (i.e. communicable disease, physical limitations:

Section III: Educational Record

Section 3 of 8
Highest level of education
Degree/diploma held
School granting degree/diploma
Year degree/diploma received
College Major/Minor

Section IV: Experience

Section 4 of 8
Please list all experience (Adventurers, Scouting, Sabbath School, Etc.) that might qualify you for Adventurer leadership:
For each experience list postion/type of work, church/organization, and date(s) of service.

Section V: Honor Instruction Ability

Section 5 of 8
Please list the skill areas and knowledge base that may be helpful with honors and crafts in which you are interested in teaching.
For each honor or craft indicate if you are: capable of teaching, able to assist, or interested in learning to teach.

Section VI: Background

Section 6 of 8
As a result of our concern for the safety and protection of children and youth, we require all potential volunteers to: 1) complete and return this Volunteer Data Sheet, 2) Have three Recommendation Forms completed, 3) Background Check Permission form, 4) Read and agree to follow the Guidelines For Volunteers and Caregivers.
Have you ever been convicted of a felony?

YesNo
Have you been denied legal custody of your children in any legal proceedings, including divorce decrees or settlements?

YesNo
Have you ever been accused of, charged with, disciplined for, or convicted of any unlawful sexual conduct, abuse, child abuse, child neglect, and/or child sexual abuse?

YesNo
Have you been required to register as a sex offender in any jurisdiction?

YesNo
If you answered yes to any of the above, please supply the date, place, type of conduct, disposition and a sentence as applicable.

Section VII: Recommendations

Section 7 of 8
Please list the three individuals who will be sending in your recommendation forms:
Name #1
Postion #1
Phone Number #1

Area CodePhone Number
Address #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name #2
Postion #2
Phone Number #2

Area CodePhone Number
Address #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name #3
Postion #3
Phone Number #3

Area CodePhone Number
Address #3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Section VIII: Statement of Accuracy

Section 8 of 8
The information contained in this form is current to the best of my knowledge. I understand that this is strictly a volunteer position, and I expect no remuneration for services and time volunteered.

I authorize any persons giving a reference or chuches listed in this form to disclose information that they may have regarding my character and fitness for serving in a volunteer ministry that may involve children or youth. I hereby release any individual, church, or organization from any and all liability for damages which may result to me, my heirs, or family for compliance with this authorization, and agree that the church may maintain this information. My signature on this form confirms my understanding and agreement that: In the event that allegations of criminal or sexual misconduct arise regarding my conduct while I serve in a volunteer capacity, the church will fully cooperate with any investigation. I further state that I have carefully read the foregoing release and understand the contents thereof, and that I sign this release as my own free act. This is a legally binding agreement, which I have read and understand.

Further, I have read and agree to follow the Guidelines for Volunteers and I give my consent for a voluntary criminal background record check.
Volunteer’s Signature*

Clear
Please be sure you have answered every question and signed your name above. Application cannot be accepted without a signature.
Date of Signature*

MonthDayYear
Purpose

The Adventurer Volunteer Data Sheet assists churches in appointing the best possible individuals to serve within the pathfinder ministry of the church. This form is part of a screening process which protects the volunteers, while also serving to protect children and youth from predators and the Church from liability. This record, once turned in, becomes the property of the local church. Applicants may request that a copy of their Adventurer Volunteer Data Sheet be forwarded to another church should they move their membership.

Procedure

Copies of this Adventurer Volunteer Data Sheet are available from the local church Adventurer Director or the Ohio Conference Youth Dept. Adventurer Directors are responsible for distributing forms to prospective volunteers and making certain that they have completed the screening process prior to serving.

The completed forms are returned to the Ohio Conference Youth Department. The Applicant agrees to participate in any orientation or training programs conducted by the church or conference. The Adventurer Volunteer Data Sheet shall be shared with another church entity only upon the applicant’s written request. Any such requests will be attached to the original document and kept on file.

Policy

All information in this Adventurer Volunteer Data Sheet is required by the Ohio Conference of SDA. The information on this form shall be kept confidential and become a permanent record of the Seventh-day Adventist Church. Volunteer records should be updated every three years. In the event of accusations agains the applicant, opportunity shall be given for response by the accused. Such a response will also become a part of the record and must be attached to this form
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Ohio Conference: Adventurer Volunteer Data Sheet

Section I: Personal Record

Section II: Health History

Section III: Educational Record

Section IV: Experience

Section V: Honor Instruction Ability

Section VI: Background

Section VII: Recommendations

Section VIII: Statement of Accuracy