SAFE CHURCH: Volunteer Screening Questionnaire Under 18 • Menai Baptist Church

MENAI BAPTIST CHURCH SAFE MINISTRY SCREENING FOR UNDER 18'S

Please Note: This is a sensitive document that will be stored in a confidential manner accessible only to a limited number of authorised persons. Full records of the processes below (including interview notes, referee checks and induction content) will be kept in the relevant staff and volunteer admin file)

1. Personal Details:

First Name *

Last Name *

Gender *

Male

Female

Date of Birth *

Phone Number: *

Email Address: *

Home Address *

Home Address Line 2

Home State *

Post Code: *

Do you have any health conditions that we should know about?

Churches you have attended regularly in the past 3 years:

Name of Church:

Location:

When attended:

Name of Church:

Location:

When attended:

REFEREES:

Please provide details of two referees who are over the age of 18 years and able to give a verbal report on your character and suitability for ministry. Referees may be part of the church.

Name: *

Phone Number: *

Name: *

Phone Number: *

Please answer the following questions:

1. Have you ever been charged and/or convicted of a criminal offence? *

Yes

2. Have you a history of alcohol or substance abuse including prescription, over-the- counter, recreational or illegal drugs? *

Yes

3. To your knowledge, has there ever been any allegations made against you regarding any abuse of a child, physical abuse or sexual misconduct? *

Yes

PARENT PERMISSIONS REQUIRED:

Medical Treatment Consent: *

Yes

Tip: I being the parent/guardian of the above child(ren) understand that whilst every precaution will be taken to ensure the good welfare and protection of my child(ren), Menai Baptist Church (MBC), its staff and volunteers acting on behalf are hereby released from any and all liability in the event of any accident or misfortune, damage or loss that may occur to the child(ren) or their property. In the case of an emergency, I hereby give permission to the First Aid Staff to ensure proper treatment for my child(ren). I understand that every effort will be made to contact me before instituting such procedures. I agree to pay all such doctor, ambulance and hospital fees incurred on behalf of my child(ren). I have detailed any health information about my child(ren) that the First Aid Staff need to know.

Involvement Consent *

Yes

Tip: I being the parent/guardian of the above child(ren) hereby give my consent that my child(ren) may participate in any activities they choose over the course of the MBC Kids and MBC Youth.

Photography and Video Consent *

Yes

Tip: I being the parent/guardian of the above child(ren) hereby give my consent for my child(ren) to be captured in both photographs and video at MBC Kids and MBC Youth. Menai Baptist Church reserves the right to use this material for promotional purposes.

DECLARATION:

I, *

sincerely declare that:-

The information I have provided in this application is true and correct to the best of my knowledge and belief.
I understand that if I provide false or misleading information or withold relevant information from this questionnaire, the church leadership may determine that I am unsuitable to serve in any role in the church.
I have received a copy of the Code of Conduct and am willing to uphold it.

Signature of Applicant:

Date: *

Name of at least one parent/guardian: *

Contact phone for parent/guardian: *

Signature Parent/Guardian:

Date: *

For Office Use Only

Volunteer Code of Conduct

Completed and Approved

Uncompleted

Safe Ministry Screening Questionnaire

Completed and Approved

Uncompleted

Interview led by:

Date:

Referee checks conducted by:

Date:

Volunteer endorsement* by:

Date:

Induction led by:

Date:

* Volunteers must be endorsed by a member of Pastoral Staff, Leadership Council or Safe Church Team.

Full records of the above processes (including inerview notes, referee checks and induction content) must be kept in the relevant staff and volunteer admin file.