Form

Application Date

- Month - Day Year

Your Full Name

First Name Last Name

Your Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Have you been at this address less than 2 years?

Yes

Previous Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

- Area Code Phone Number

Cell Phone

- Area Code Phone Number

E-mail

Occupation

Place of Employment

Date of Birth

- Month - Day Year

Social Security Number

Marital Status

Single Married Widowed Divorced/Separated

Spouses Full Name

First Name Last Name

Is your spouse supportive of this service commitment?

Yes No Uncertain

If you are a Middle or High School student please provide your parent's names.

Is RHCC your church home?

No Yes

What is the name of your home church?

In which area(s) would you like to serve (check all that apply)?

List the serving ministries, both at RHCC and in your community where you currently are serving.

List your gifts, training, or education that would relate to serving children/students:

List previous volunteer experience with children, age infant - 12th grade, including dates of work, church/organization name, location and work performed:

Describe how and when you decided to trust Jesus Christ alone for your salvation, or where you are on your faith journey.

How do you consistently nurture your relationship with Him?

First Reference Name

First Name Last Name

First Reference E-mail

First Reference Phone Number

- Area Code Phone Number

Second Reference Name

First Name Last Name

Second Reference E-mail

Second Reference Phone Number

- Area Code Phone Number

Have you ever been accused of, arrested for, convicted of, or pleaded guilty to any crimes other than traffic violations? *

Yes No

Please provide a full explanation for answering Yes to the question above:

Are there any circumstances involving your lifestyle or your background that could call into question your ability to work with children, or that would compromise the integrity of RHCC? *

Yes No

Please provide a full explanation for answering Yes to the question above:

Safety/Secuity policy

Should you suspect that a child/student under your care is being neglected or physically or sexually abused, it is important that you contact the Pastor or Director over your ministry age group at the earliest opportune time. A pastor or Director is a Mandatory Reporter and will take any necessary action. As a volunteer, you should not conduct an "interview" with the child or make contact with the parents. This is the responsibility of the Pastor or Director. Any information told to you should be kept confidential.

Your service requires that you agree with the following guidelines to prevent child abuse or false accusations of abuse. Following these guidelines will help protect both Rolling Hills Community Church and you, our valued volunteer, from liability.

Restrooms/Diapering

Volunteers may never be alone with a child/student in the restroom or diapering area. Another child or adult must be present at all times.
Elementary children may enter the restroom without the supervision of an adult, but an adult must escort them to and from the restroom.
To maintain privacy, a bath room stall should be entered by an adult only when absolutely necessary to assist the child. The stall door and exterior door to the hallway must remain open and another adult needs to be present.
Diapers are to be changed in designated areas only and in the presence of other volunteers.
When assisting children who are potty training, be sure all doors are open and other volunteers are present.

RHCC classrooms/off campus activities

A child/student must never be alone with an adult. Classroom doors should be propped open when children/students are arriving, especially when only one child/student is in the room.
Physical contact is permissible, but should be kept to a minimum and in the presence of other adults and children. Appropriate touching includes handshakes, "high fives," brief side hugs, or a brief touch on the shoulder.
Infants/Toddlers may, of course, be comforted appropriately.

Applicant Release

The information contained in this application is correct to the best of my knowledge. I authorize any references, churches, or other organizations listed in this application to give Rolling Hills Community Church any information they may have regarding my character and fitness for working with children, and i release all such references from liability for any damage that may result from furnishing such information. I give permission to Rolling Hills Community Church to conduct a criminal background check to verify that I do not have a criminal record that would affect my ability to work with children. Should my application be accepted, I agree to follow the policies of RHCC and to refrain from unscriptural conduct in the performance of my services on behalf of the church. I understand that my personal information will be help confidential by the professional church staff.

I have carefully read the foregoing safety/security policy, reference statement, background questions, know the contents thereof and sign this release as an act of my free will. *

Please type your name in the box provided.

Enter the message as it's shown *

RH/Kids Volunteer Application

Special Note - please read this:

Applicant's Personal Information

Applicant's Gifts & Experience

Applicant's Relationship with God

Applicant's References

Applicant's Background Questions

Policies & Applicant's Agreement