Select Your Age Group *
ADULTS: After completing this form, you will receive an email from checkr.com, our third-party, background-check partner, in order to complete a secure background check.
Select… Adult: Currently 18 Years of Older Student: Currently 17 Years or Younger
Do you live in the United States? *
Are you a United States citizen? *
Gender *
Select… Male Female
Phone Number *
Phone type Mobile Home Work Other
Select T-Shirt Size *
Select… Youth Small Youth Medium Youth Large Small Medium Large X Large 2X Large 3X Large
Preferred Service Time(s) *
Who encouraged you to apply? *
(If it was your leader, please list by name)
Excluding traffic related offenses, have you ever been accused or convicted of criminal activity, or entered a plea of guilty or no contest to a criminal offense of any kind? *
Have you ever been accused or convicted of sexual misconduct, or entered a plea of guilty or no contest to abuse or sexual misconduct? *
Are you aware of any traits or tendencies that you possess that could pose a threat to children or youth? *
I recognize that Kenosha City Church is relying on the accuracy of the information I provide on this application. I attest and affirm that the information I have provided is absolutely true and correct. *
Please Initial
I authorize Kenosha City Church to contact any person or entity listed on application, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications. *
Please Initial
I voluntarily release Kenosha City Church and any such person or entity listed on this application from liability involving the communication of information relating to my background or qualifications. *
Please Initial
I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any consumer report on me. I also understand that I may receive a written summary of my rights under 15 U.S.C. § 1681 et. seq. *
Please Initial
I acknowledge that I am volunteering my time and efforts in service for Christ through the ministries of Kenosha City Church, and that I will receive no monetary compensation or insurance benefits for my time or services performed. *
Please Initial
I acknowledge and accept the risk of physical injury that could occur from my participation as a volunteer. *
Except for gross negligence on the part of Kenosha City Church, I accept personal financial responsibility for any bodily or personal injury sustained while I am volunteering. Further, I release and agree to indemnify and hold harmless Kenosha City Church, and its officers, directors, and representatives from any liability, injury, damage, loss, accidents, delay, or irregularity related to being a volunteer for Kenosha City Church.
I grant to Kenosha City Church the right to make photo, video, and audio recordings of me. *
("Recordings") as well as the perpetual, world-wide right to record, re-record, copy, edit, reproduce, publicly display, perform, and distribute the Recordings in any way consistent with Kenosha City Church's ministry, including use on the Internet. I waive the right to inspect or approve the finished product wherein the Recordings appear.
Please note the following release does not apply to any personal, professional, or other project/work that is unrelated to Kenosha City Church. *
Any work that I have created in my role/capacity as a volunteer for Kenosha City Church in the past, present, or future, recorded in any form ("Creative Work") is for the exclusive ownership of Kenosha City Church and is considered a "work made for hire" (defined in the US Copyright Act). If, for any reason, the work related to my volunteer service for Kenosha City Church is determined at any time not to be a "work made for hire," I agree to assign, and do assign, to Kenosha City Church all right, title, and interest to the Creative Work.
Kenosha City Church wishes to maintain in confidence all information including data, commercial, and strategies, and know-how disclosed by Kenosha City Church to me, directly or indirectly, in written, oral, or other tangible forms. *
In this regard, I agree that I will not disclose the confidential information and/or trade secrets with others without prior written consent of Kenosha City Church both during or after my volunteer service.
Additionally, I agree to all statements above and certify that I have properly initialed each statement and/or accept that any text placed in the fields provided will be considered acceptance of the statements.
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