This form is to be completed by all adults who regularly engage in the supervision of students at The Gate. it is being used to help The Gate attempt to provide a safe and secure environment for students who participate in its programs , and to the extent possible, protect the volunteers who work with students. This information is to be kept confidential.

Name

Please print Legal Name

First Name

Last Name

Previous/Maiden Name:

Gender

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthday

YYYY

Experience

Please list previous work involving children/students, identifying the place/organization, type of work and the dates, and your responsibilities.

Testimony

Please briefly share your testimony of how you came to know Christ. Also share why you want to volunteer and work with students at The Gate.

Are you CPR/AED Certified?

Volunteer Manual

I have read and agree to follow the guidelines stated in the volunteer manual

Days Interested

Monday | 7:15-11:45AM

Monday | 1:15-5:45PM

Tuesday | 7:15-11:45AM

Tuesday | 1:15-5:45PM

Wednesday | 7:15-11:45AM

Wednesday | 1:15-5:45PM

Thursday | 7:15-11:45AM

Thursday | 1:15-5:45PM

COVID-19 REGULATIONS

PLEASE CHECK THE FOLLOWING CONCERNING COVID-19 REGULATIONS *VOLUNTEERS MUST ADHERE TO ALL GUIDELINES*

I assume risk of entering The Gate's facility, potentially being exposed to illness related to COVID-19

I understand The Gate is not liable if I contract COVID-19

I will wear a mask while inside The Gate's facility, unless eating or drinking

I will adhere to social distancing requirements outlined by The CDC

I agree to work alongside students and The Gate staff (adhering to social distancing guidelines outlined by The CDC)

Background Information

The questions below are part of a process that helps us provide a safe and secure environment for our students. In caring for out students, we believe it is our responsibility to seek volunteers that are able to provide healthy, safe and nurturing relationships. Please answer the following questions accordingly. Any special concerns can be discussed individually with The Gate staff. Any information indicating that a candidate poses a threat to others or has any prior history of physical or sexual abuse directed against another person will result in the immediate removal of the individual candidate from consideration for a volunteer position with this The Gate. Any applicant declining to complete a background check will not be considered.

Have you ever pled guilty, or been convicted of a felony in a state or federal court?

Have you ever pled guilty, or been convicted or a misdemeanor in a state or federal court?

Are you on the sexual offender registry?

Are you the subject of a current criminal investigation or have pending charges against you?

Have you ever been accused, charged or convicted of any form of child abuse or neglect (sexual, physical, etc.)

Have you had any sexual relations with any minor after you became an adult?

Would you be willing to discuss any of the above matters with staff from The Gate or a counselor?

The Gate reserves the right to approve or deny any volunteer service upon the review of the background check returned. The determination will be based upon the individual’s fitness to have responsibility for the safety and wellbeing of students. Providing false information, or information contradicting to the background check information, is grounds for immediate volunteer denial. This form authorizes The Gate to obtain background information and must be completed by the applicant. The Gate must keep this completed form on file for at least two years after requesting a background check. I, the undersigned applicant (also known as “consumer”), authorize The Gate to produce background information (also known as a “consumer report and/or investigate consumer report” about me.) This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to The Gate, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.

I have read, understand and accept the terms above, sign by typing your full name.

YYYY

Volunteer Sign Up Form

Before filling out this form, please read through our Volunteer Manual