First Universalist Church

Safe-Congregation Policy

A Policy for the Prevention of Sexual Misconduct,
Physical Abuse and Harassment

Religious Education Program Volunteer References

Thank you for your interest in becoming a volunteer with the First Universalist Church of Yarmouth's Religious Exploration program. As a child-serving program, the RE program is concerned about the safety and welfare of all our children and youth. For this reason we feel it is important to obtain some information about our volunteers. Please fill out the following information sheet and return it to the DRE with the signed Code of Ethics and Affirmation. We appreciate your support in providing a safe and secure environment for all the young people of our church.

Volunteer's Name

________________________________________________________
First                                      Middle                                             Last

Address

_________________________________________________________
Street # and Name                           City/Town                            Zip Code

Home Phone Number:_______________  

When is the best time to reach you at home?______________________

Work Phone Number:________________  

May the DRE phone you at work?  __ Yes           No

If yes, when?____________________________

If you have not lived in your current town for 5 years, please list the cities and states where you have lived for the last 5 years.

________________________________________________________

________________________________________________________

Please list 2 references who have known you for at least 2 years and are familiar with your character as it pertains to your experience with children and/or youth.

1) Name_____________________________    Phone _____________

      Address_______________________________________________

2) Name_____________________________    Phone _____________

      Address_______________________________________________

I authorize The First Universalist Church of Yarmouth to contact references to obtain information about my background. I authorize references to provide such information about me. This information will be available only to those responsible for screening or participating in a response team, or as required by law.

Signature_____________________________     Date______________

back to Policies

back to Safe-Congregation Policy Contents