Adult Volunteer Application

Today's Date

Contact Information

Name *

First

Middle

Last

If you do not have a legal middle name, please indicate "NA"

Primary Phone Number *

Email *

Your Church *

Other

Volunteer Information

Are you submitting this volunteer application because you've agreed to volunteer at a youth camp or retreat this year? *

Yes
No
I'm getting my application completed in anticipation of a future volunteer opportunity.

If you said "Yes," that you're submitting this application because you've agreed to be a volunteer this year, please indicate what age group you'll be working with.

Younger Children Grades 2-3
Older Children Grades 4-6
Younger Youth Grades 7-9
Older Youth Grades 10-12
Not applicable- interested in future volunteer opportunities.

If you indicated that you're submitting this application in anticipation of a future event, what youth age groups or programs are you interested in volunteering with? *

Skills and Interests: What special skills/interests do you have that might be relevant to the Northern Lights Region youth/camp/outdoor programs (i.e. bible study, music, sports, crafts, hiking, etc.)?

Background Check and Covenant

Have you ever been disciplined for, charged with, or convicted of an act of sexual misconduct or child sexual abuse? *

No
Yes

Have you ever been convicted of a felony? *

No
Yes

BACKGROUND CHECK AUTHORIZATION

The Christian Church (Disciples of Christ) in the Northern Lights Region conducts background checks through the Praesidium company. When you submit this application, your contact information will be used to have an electronic background check authorization form sent to you by Praesidium. Please watch for that email within 24-48 hours of submitting this form. If you do not receive the email, please contact the office of the Northern Lights Region

Per this region's Youth and Children's Safety Policy, all persons participating in NLR events for youth or with youth, must agree to a background check.

COVENANT

This submitted application also affirms the following Covenant:

I desire to serve as a volunteer working with youth for the Northern Lights Region. I understand that personal references may be contacted to confirm my character and abilities as appropriate for leadership at the events I participate in. I promise to cooperate with other volunteers, counselors, directors and staff and to uphold all standards set forth by the Region and the event leadership. With God’s help, I will seek in every way to provide an experience on the highest Christian level for all who attend the event which I serve. I will participate in all training opportunities planned for the event and at all times will conduct myself as the Christian example I am called to be.

I understand this application is good for three years from the date this form is submitted and will need to be completed again at its expiration.

References

Two References are necessary for a complete application.

One reference must be your pastor. In the case of clergy applying the Regional Minister must be your pastoral reference. For those congregations without a called pastor the Moderator/Chairperson of the church board or Youth Group Leader may be substituted.
In addition to one reference from a minister select one person familiar with your character as it relates to working with children or youth.
Do not include a relative or significant other; the two references should not be related to one another.
YOU ARE RESPONSIBLE FOR YOUR REFERENCES RETURNING THEIR FORMS TO THE REGIONAL OFFICE.

Open this page and bookmark the form to share with your selected references. The form link can also be found in the Ministries>> Youth and Children's Ministries menu item of the Northern Lights Region website.

northernlightsdisciples.org/adult-volunteer-reference-form