KidzMin Adult Volunteer Application - Peninsula Community Chapel

Your name *

Email address *

Address *

Phone number *

References

Please provide:
- 1 personal reference (NOT related to you)
- 1 professional reference (prefer a reference that would know your experience with children)
- 1 PCC reference (or if you do not have a PCC reference due to being new, list a person from your past church)

Personal Reference *

First and Last Name

Nature/Length of Association: *

Professional Reference *

First and Last Name

Nature/Length of Association: *

PCC Reference (PCC Regular Attender or Member) *

First and Last Name

Nature/Length of Association: *

Length of time attending PCC: *

Home Group Leader (if applicable)

Please list previous church if you have attended PCC for less than 6 months (enter N/A if not applicable)

List all current and previous experiences working with children (church, vocational or volunteer):

Please list other areas where you are currently involved at PCC (or if new, where you enjoyed serving in the past):

Check volunteer position(s) of interest in KidzMin:

Nursery - 9am Service

Nursery - 10:45am Service

Preschool - 9am Service

Preschool - 10:45am Service

Elementary - 9am Service

Elementary - 10:45am Service

Safety Team

Welcome Team

Buddy Ministry

Large Group Worship Team

Please briefly tell us your testimony and how you came to know Christ: *

Agreement to Uphold PCC Major Doctrines

All persons desiring to teach in KidzMin at PCC must agree with the Major Doctrines section of our church’s Doctrinal Positions. PCC Doctrinal Positions can be accessed on the Forms & Documents page on the PCC Website.

By signing below, I indicate that I have carefully read the Major Doctrines section of the Peninsula Community Chapel doctrinal positions, fully agree with them, and commit to teaching in a manner consistent with them. Should my position ever change on any of these, I will immediately let KidzMin leadership know and allow them to place me in a different role if available.

Digital Signature of Agreement

First and Last Name

Code of Ethics

- I desire to model Christ-likeness in all my behavior, especially as I serve in ministry to children at Peninsula Community Chapel. I am to demonstrate my love for the Lord Jesus, my gratitude for His grace and forgiveness, and testify to the power of the Holy Spirit working in my life.
- I desire to demonstrate respect, loyalty, patience, courtesy and maturity.
- I will treat kids of all races, religions, and cultures with respect and consideration.
- I will not abuse kids in any way, including but not limited to: Physical Abuse, Verbal/Mental Abuse (humiliate, degrade, threaten, etc), Sexual Abuse (e.g. inappropriate touch or exposure)
- I will not use or tolerate profanity in the presence of children.

Have you ever engaged in any conduct that would be regarded as criminal child abuse or neglect? *

Yes

Have you ever been convicted of any felony? *

Yes

Do you have any health issue or history of emotional illness that would currently place children, other workers or yourself at risk? *

Yes

Safety Training - Required before serving in KidzMin *

- Go to pccyorktown.com/kidzmin-volunteers
- Scroll down to the KidzMin Safety Training Video (Password: kidzmin101)
- Watch the video
- Complete the Safety Training Quiz

Please sign your name confirming you will complete this mandatory step.

Background Check Requirement:

All adult volunteers are required to complete a background check before serving with children at PCC. You will receive an email from CHECKR with this request. Please complete this form as soon as possible. Additionally, every two years we will ask to run a background check on each volunteer. You will be notified when this request is sent again.

Please sign below acknowledging that you understand that a background check must be completed before serving.

Digital Signature *

First and Last Name

References

Church Involvement

Agreement to Uphold PCC Major Doctrines

Code of Ethics

Background Check Requirement: