Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

When would you be available to begin volunteering? *

MM

DD

YYYY

Which day(s) are you available to volunteer? *

Monday

Tuesday

Wednesday

Thursday

For which program would you like to volunteer? *

Victory Reading (during the school year)

Summer Enrichment

VBS

Lion Hearts (Trail Life Troop #7777)

Crafting Club

Have you ever engaged in or been convicted of child abuse or a crime involving actual or attempted sexual molestation of a minor, or are charges pending? *

Yes

No

Have you ever been accused or convicted of rape? *

Yes

No

Do you agree to have a Sex Offender and Child Abuse/Neglect Registry check and/or a Criminal History check? *

Yes

No

Because you will be a role model, do you understand that you cannot exhibit the use of tobacco or alcohol, inappropriate behavior, or inappropriate language during outings and meetings? *

Yes

No

Do you engage in any type of drug or substance abuse? *

Yes

No

Personal Reference #1 *

First Name

Last Name

Personal Reference #1 Phone *

(###)

###

####

Personal Reference #2

First Name

Last Name

Personal Reference #2 Phone

(###)

###

####

Children are a precious gift of God. We take seriously our responsibility to ensure that children in our care are carefully supervised by individuals who are carefully selected, qualified, and trained. By signing below, I verify that all the information contained in this Application for Children/Youth Work is accurate and current to the best of my knowledge. I hereby assign and grant STEP/Victory Life Fellowship the right and permission to use and publish the photographs/film/videotapes/electronic representations and/or sound recordings made of me by STEP, and I hereby release STEP from any and all liability from such use and publication. I hereby authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/videotape/electronic representations and/or sound recordings without limitation at the discretion of STEP and I specifically waive any right to any compensation I may have for any of the foregoing. *

First Name

Last Name

Date *

MM

DD

YYYY

I am in agreement with the STEP Statement of Faith. *

Please review the STEP statement of faith at https://www.steprichmond.org/statement-of-faith or by clicking the link at the top of this page.

First Name

Last Name

Date *

MM

DD

YYYY