Name *

First Name

Last Name

During your lifetime have you ever been accused of the exploitation of a minor, physical assault or sexual offense of any kind?

no

yes

Are you listed on the sexual offender registry of any state?

No

Yes

As a child, were you ever molested, abused, assaulted or subjected to a sex offense of any nature?

No

Yes

Have you ever been convicted of a crime?

No

Yes

Have you received, read and agree to comply with Redeemer's sexual misconduct policy?

No

Yes

Do you agree to report any conduct or inappropriate behavior of other volunteers to the staff?

No

Yes