Appendix C

Towson

United Methodist Church

501 Hampton Lane

(Beltway Exit 27B & Dulaney Valley Road) email: towsonumc@towsonumc.org

Towson, Maryland 21286 410-823-6511 Elevator is available to access all 3 floors!

Sunday Morning Worship: 8:30 & 11:00 with Graded Sunday School & Adult Christian Connections at 9:30 AM

APPENDIX C

POLICY OF THE TOWSON UNITED METHODIST CHURCH FOR THE PREVENTION OF ABUSE OF CHILDREN AND YOUTH

VOLUNTEER APPLICATION

The Towson United Methodist Church

501 Hampton Lane

Towson, MD 21286

Date: _____________________

Personal Information

Name (Last Name, First Name, Middle Name)		Social Security Number
Present Address	City	State	Zip Code
Permanent Address	City	State	Zip Code
Phone No ( )	Referred by
Are you under the age of 18 YES _____ NO _____	Drivers License Number & State

Volunteer Information

Position	Date you can Start	Days/Time Available

Special Skills & Gifts

Please list any special training or skills, organizations, hobbies

References Give below the names of 3 persons not related to you, whom you have known at least 1 year

Name	Address	Phone	Business/Title	Yrs Known

Have You Ever…

Been convicted of a crime other than minor traffic violations YES _____ NO _____	If yes, please explain
Been convicted of a traffic offense in the last five (5) years YES _____ NO _____	If yes, please explain

Have You Completed…

First aid training? YES _____ NO _____	If yes, date completed
CPR training? YES _____ NO _____	If yes, date completed
AED training? YES _____ NO _____	If yes, date completed

APPLICANT’S STATEMENT

The information contained in this application is correct to the best of my knowledge. I authorize any references listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for work. I release all such references from any liability for furnishing such evaluation to you, provided they do so in good faith and without malice. I waive any right that I may have to inspect references provided on my behalf. Should my application be accepted, I agree to be bound by the policies of this church and to refrain from unscriptural conduct in the performance of my service on behalf of this church.

I further state that I have carefully read the foregoing releases. This is a legally binding agreement that I have read and understood.

Applicant’s Signature _______________________________ Date ____________

Do Not Write Below This Line__________________________________________________________________

Remarks