BACKGROUND CHECK - for youth under 18 years to complete

Redeemer requires that churches have this form completed by the called staff, staff and all volunteers working with children/youth programs. This form is part of Redeemer Lutheran Church’s policy of preventing child abuse in any form in the church. All called staff, employees, and volunteers will be required to complete the form, regardless of the length of time they have worked with children or youth. Your complete and accurate answers are necessary.

The information you provide will be held in strict confidence and will not be disclosed beyond what is reasonably necessary or legally required. This information will protected under lock and key.

Name

First Name

Last Name

Address

Phone

Email Address

Program/Activity you will be helping with/volunteering for at Redeemer:

During your lifetime, have you ever been accused of the abuse, or any nature, of anyone else?

no

yes

If you answered yes, please explain the nature of the accusation, charge, or conviction

Have you read and understood the Abuse Prevention Policy?

No

yes

Do you agree to immediately report any behavior or conduct by any other worker/volunteer that seems abusive or inappropriate to Redeemer's Pastoral Staff or Minister of Youth and Education?

No

Yes

Do you agree to report if any abuse is committed against you?

No

Yes

I hereby certify that I have read and completed the above screening form. My answers are true and correct to the best of my knowledge. Please sign full name below:

Date

Parent or Guardian Full Name

To read Redeemer "Abuse Prevention Policy", click here.