Adventurer Volunteer Data Sheet: UPDATE

Adventurer Volunteer Data Sheet: UPDATE

This form only needs to be filled out every three years. (After the initial Adventurer Volunteer Data Sheet is completed.) Thank you for assisting us in maintaining accurate and current information.
Section I
Name*
Birthdate*

MonthDayYear
E-mail
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Work Phone*

Area CodePhone Number
Church*
Adventurer Club*
Marital Status*
Name of Spouse
Are you presently an Adventurer staff member?*

YesNo
What position in the club do you hold?
Section II
List any injury/disability/health factor that might limit your involvement in ministry activities, or impact the health of children (i.e. communicable disease, physical limitation.
Have you ever been convicted of a felony?*

YesNo
Have you been denied legal custody of your children in any legal proceedings, including divorce Decrees or settlements?*

YesNo
Have you ever been accused of, charged with, disciplined for, or convicted of any unlawful sexual conduct, abuse, child abuse, child neglect, and/or child sexual abuse?*

YesNo
Have you been required to register as a sex offender in any jurisdiction?*

YesNo
If you answered yes, please supply the date, place, type of conduct, disposition and a sentence as applicable.
Section III
Applicant’s Social Security Number*
Birth Date*

MonthDayYear
The above information is accurate to the best of my recollection. I understand this is strictly a volunteer position and I will receive no remuneration for services and time volunteered. I also give my permission for the Ohio Conference to run another background check on me.: Applicant’s Signature of Consent*

Clear
Date of Signature*

MonthDayYear
Should be Empty:

Adventurer Volunteer Data Sheet: UPDATE

Section I

Section II

Section III