Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #1 *

(###)

###

####

Phone #2 (optional)

(###)

###

####

Do you consent to a background check? *

This is required before volunteers can work with students. If you have concerns about this, please call us at 234-5545.

Yes

No

Birthdate *

Required for background check

MM

DD

YYYY

In which area(s) of ministry are you most interested? *

Sunday AM small group leader

Wednesday PM small group leader

Mentor

With what age of students are you most interested in serving?

Junior High

Senior High

Wherever I'm most needed