Rialto SDA Church

Personal and Family Information

Health History

Education Record

Experience

List all experience working with children (Pathfinders, Scouts, Sabbath School, etc.)

Adventurer Club Staff and Parent Volunteer Information

Have you been accused, charged, or disciplined for any unlawful sexual conduct, child abuse, and/or child sexual abuse?

If yes, please complete the information below.

References (for staff only)

List three individuals who know you well enough to recommend you as an Adventurer staff member. Please include name, address and phone number.

Statement of Accuracy

The above information is accurate to the best of my recollection. I understand this is strictly a volunteer position, and I will receive no remuneration for services and time volunteered.