What skills would you bring to the children's/youth program?

What other children's/youth work experience do you have? (Please list including Organization, Program, Dates and Contact)

Been arrested for any reason?

Children’s/Youth Volunteer Verification and Release

I recognize that Vine & Branches Porter County is relying on the accuracy of the information I provide on the Children’s/Youth Volunteer Application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct.

I authorize the organization to contact any person or entity listed on the Children’s/Youth Volunteer Application form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.

I voluntarily release the organization and any such person or entity listed on the Children’s/Youth Volunteer Application form from liability involving the communication of information relating to my background or qualifications. I further authorize the organization to conduct a criminal background investigation if such a check is deemed necessary.

I have carefully read the policy and procedures of the organization, and I agree to abide by them and to protect the health and safety of the children or youth assigned to my care or supervision at all times.

By typing your name below you are agreeing to the above statement