Pathfinder Club Staff and Parent Volunteer Information

Phone

This field is for validation purposes and should be left unchanged.

Personal and Family Information

Name*

First Last

Birth date*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone

Country Phone Number

Cell phone*

Country Phone Number

Email*

Church

Adventurer Club

Name of spouse (if applicable)

Children: Name – Birth date: Month – Day – Year

Health History

Do you have any injury/sickness that might limit your involvement in Pathfinder Club activities? If yes, how would it hinder?

Yes/No

Yes

Education Record

Highest degree/diploma held

Year degree/diploma received

School granting degree/diploma

College major/minor

Experience

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

Position / type of work / Church / organization / Date of service

Pathfinder 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?

Yes/No

Yes

If yes, please complete the information below.

Date/place

Type of conduct

Reference name, address, and phone

Background Check*

I will complete the background screening and training required by our conference.

References (for staff only)

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

References*

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.

Signature*

Date*