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BIG SDC YLC
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Peace Jr. Fellowship
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BIG SDC YLC
Help-U-Learn
Peace Jr. Fellowship
Contact
Since 1998
PERSONAL LIFESTYLE QUESTIONS (PART 6 OF 7)
I certify that the below information is filled out with utmost accuracy and honesty.
*
Please sign your name below.
In caring for children, we believe it is our responsibility to seek adult staff who are able to provide healthy, safe and nurturing relationships. Please answer the following questions accordingly. Any special concerns can be discussed individually with the director or pastoral staff.
6a) Has anyone, including church or civic authorities, ever accused, arrested, or convicted you of any crime(s)?
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Yes
No
If yes, please explain:
6b) Has anyone, including church or civic authorities, ever accused, arrested, or convicted you of any improper conduct toward any child(ren)?
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Yes
No
If yes, please explain:
6c) Is there any fact or circumstance involving you or your background that would call into question you being entrusted with the supervision, guidance, and care of young people?
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Yes
No
If yes, please explain:
6d) Have you ever been concerned that you may have an addiction to drugs, alcohol, pornography, or any other addiction, or has anyone ever suggested that you may a have problem with any of these issues?
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Yes
No
If yes, please explain (including what steps have you taken to minimize the impact that those issues will create for you, both now and the future).
Additional Questions/Comments:
This can include anything from any of the above sections.
