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Lat45 Adventure Ministries

Safety Application Form for Volunteers and Employees

Confidential


This application should be completed by all applicants for any position (volunteer or employment) involving the supervision of minor children or vulnerable adults, such as elderly or impaired persons. This is not an employment application. The purpose of this form is to assist in the creation of a safe environment for children, students and vulnerable adults who participate in the programs offered by Lat45.

RELEASE I authorize Lat45 to contact all individuals, organizations and references listed on this Safety Application Form in order to verify the information I have provided to Lat45. I agree to release from liability any person or organization that provides information concerning me, including those persons I have listed as references, as well as contact persons from my previous church and nonchurch work, listed on this application. I specifically authorize the church to undertake a criminal background check concerning my past. I understand and agree that any information received from the background check and application verification will not be disclosed to me, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form. By signing this form, I certify and affirm that the information I have given on this form is true, complete and correct in all respects.

May 3, 2024

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Church Attendance or Membership

Please list the church you attend/are a member of:

Click to customize text box label
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Marital Status:
Single
Married
Separated
Divorced
Widowed
Are you a member or regular attender of church? *
No
Yes

If so, for how long?

How long have you lived at your current address?

Previous address:

List all other cities and states where you have lived as an adult:

Please list the name, address, city and state of other churches you have attended regularly during the past 10 years:

Please list all previous church work involving children, students or vulnerable populations (impaired, adults, special needs individuals etc.). (List each church’s name and address, type of work carried out, dates, and a contact person familiar with your work there. Use back of this page for more space, if necessary.)

Please list all previous non-church work involving children, students or vulnerable populations. (List each organization’s name and address, type of work carried out, dates and a contact person familiar with your work there.)

List any talents, vocations, preparation, training or other experiences which have equipped you to work with children, students or vulnerable adults:

Please complete a separate reference form providing one professional reference (if applicable), one personal reference, and one family member. References must include one non-family member and one member of the opposite sex. Please contact these references and inform them an authorized Lat45 staff person will be contacting them. (See Reference Form for Volunteers attached.) Because our ministry cares for our participants and staff, and desires to protect them, please answer the following questions. We understand that the answers to these questions may be private and deeply personal, and we will protect your privacy. Why do you want to work with youth with Lat45?

What is your philosophy concerning re-direction or discipline of children?

When you are unhappy, angry or emotional about a person or circumstance, what do you do?

Have you experienced any significant physical or emotional stresses within the past year, such as the loss of a parent, spouse, or child, extreme ill health, or any emotional or physical crisis? If so, please briefly explain.

Do you consider yourself to have been physically or sexually abused as a child? (This information will be kept entirely confidential.)

If you were physically or sexually abused as a child, would you consider utilizing church resources to seek healing in this area of your life?

Have you ever physically or sexually abused a child?

Has someone ever accused you of abusing a child?
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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