Refuge 139 Application
Before you begin, please note that we take Child Safety very seriously. In order to participate in this program, the applicant must not have intentionally viewed pornography for a minimum of 12 months and must pass a Criminal Background Check to qualify. If you have been convicted of child abuse, you will be disqualified from volunteering with JAARS and the Refuge 139 program. If you would like clarification about this before proceeding, please email: refuge139_director@jaars.org.

PLEASE NOTE: In this application you will be asked for passport information, a professional reference, a church reference, emergency contact information, and medical history to include any prescription drugs you currently take. We recommend you gather this information before you start. Once you begin filling out this application, you CANNOT save it to continue at a later time. It must be completed and submitted in its entirety once you begin or your information will be lost. You should allow 20 - 30 minutes to complete this application. Thank you.
1910
Please list your First, Middle, and Last names.
First Name
Your answer
Middle Name
Your answer
Last Name
Your answer
Preferred Name
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Male or Female
Address Line 1
Your answer
Address Line 2
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Country
Your answer
Email Address
Your answer
Primary Phone
Your answer
Secondary Phone
Your answer
Skype Name
Your answer
How did you hear about Refuge 139?
Your answer
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This form was created inside of JAARS INC.. Report Abuse