Application for Ministry to Minors

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This application is to be completed by all workers in the church who will be working with minors. It is being used to help the church provide a safe and secure environment for those children and youth who participate in our programs and use our facilities. All information will be kept confidential.

All questions must be answered. Type "NA" if it does not apply.

Email *

First Name *

Middle Name *

Last Name *

Phone Number *

Birthday *

YYYY

Gender *

Male

Female

Current Street Address *

Town/City, State, Zip Code *

How long have you lived at your current address? *

Previous address if you recently moved to Ellendale (street, city, zip code) *

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