Youth Workers With Minors Application
(For All Youth 6th-12th Grade)

First Name

Last Name

Phone Number

Date of birth

Address

Apartment, suite, etc.

City

State

Postal / Zip Code

School

Grade

If less than one year at current address, please provide previous address:

Where are you interested in serving with minors? (Nursery, Preschool and special events)

Name of parent who is a member of Northlake Bible Church:

Length of time you have attended Northlake Bible Church: (Note: Youth workers must attend NBC for at least 6 months before submitting application to work with minors, and a parent must be a member of NBC)

In serving as a volunteer or in a paid position for Northlake Bible Church, I have read and understand, and I am willing to abide by, the policies & procedures set forth in the “Child Protection Policies and Procedures” to reduce the risk of child abuse in this church. I understand that child abuse is a serious matter and will do my part in the prevention of child abuse while serving at Northlake Bible Church.

Signature of Teen Worker

Date

There is no reason why my child should not serve as a Youth Worker with Minors. He/She does not demonstrate any signs of being a potential risk to the church or to children.

Signature of Parent/Guardian

Date Signed

Printed Name of Parent/Guardian

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Youth Workers With Minors Application(For All Youth 6th-12th Grade)

Youth Workers With Minors Application
(For All Youth 6th-12th Grade)