Epic Community Church - Wild Kids Serving Application

WILD KIDS SERVING APPLICATION

First Name

Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Phone Number

Email

Date of Birth

How long have you attended Epic Church?
Less than 3 months 3-6 months 6-12 months More than a year

Are you a partner of Epic Church?
No Yes Would like more info

Which age group do you feel most passionate about serving?
0-18 months 18 months - 3 years 3-5 year olds K-3rd Grade 4th-5th Grade Middle/High School

How often would you like to serve?
Once a month Twice a month As often as needed

If you are under 18, please list name of parent(s).

Reference #1 Name

Reference #1 Address

Address 2

Country

City

State

Zip/Postal Code

Reference #1 Phone Number

Reference #2 First Name

Last Name

Reference #2 Address 1

Address 2

Country

City

State

Zip/Postal Code

Reference #2 Phone Number

Reference #3 First Name

Last Name

Reference #3 Address 1

Address 2

Country

City

State

Zip/Postal Code

Reference #3 Phone Number

Have you ever abused, or been accused of and/or convicted of, abusing a child or spouse?
Yes No

Have you ever molested, or been accused of and/or convicted of molestation of a minor?
Yes No

Do you currently struggle, or have you struggled, with any form of pornography?
Yes No

Have you been diagnosed with HIV, AIDS, Hepatitis B, or any other communicable disease?
Yes No

I give epic-a community church the right to further investigate my background and to secure additional information about me, if job related. I hereby release from liability, epic-a community church, its employees and its representatives for seeing such information and all other persons, corporations or organizations for furnishing information. I understand that epic-a community church will run a background check on all applicants who work with children; this form will be kept strictly confidential.
I agree