If under 18, enter your birthdate (mm/dd/yyyy): You are required to read and sign the Youth Policy

Do you have any physical or mental conditions which may limit your ability to serve as a volunteer?Yes No
If yes, describe:

Have you ever been convicted of a sexual charge or crime (other than traffic violations)?  YesNo
If yes, please state offense, date, and location.  (A conviction record will not necessarily be cause for disqualification.)

Do you object to the Agency checking with appropriate public authorities (e.g. police, courts,) etc. for matters of public record regarding your background or history?  YesNo

How did you learn about our volunteer position(s)?
My Congregation, please specify: Brochure Internet Media
Other, please specify