Name *

First Name

Last Name

Phone *

(###)

###

####

Birthdate *

MM

DD

YYYY

Availability *

What is your availability?

Daily

Weekly

Monthly

Special Events

Whatever it takes!

Question 1: *

Have you ever been convicted of or pleaded guilty to any crimes (including crimes of record which have been expunged and pleas of 'no contest'), including municipal, state and federal?

YES

NO

Question 2: *

Have you ever been placed on probation, received a Suspended Execution, Suspended Sentence or Suspended Imposition of Sentence for any offense involving a minor child (a child under 18), or been placed on ANY local, state, or federal sexual registry?

YES

NO

Question 3: *

Have you ever been sued in a civil court of law where the allegations in the suit involved illegal, inappropriate, or sexual conduct or contact with a minor child?

YES

NO

Question 4: *

Have you ever been subject to any court order involving any sexual, physical or verbal abuse including but not limited to any domestic violence or civil harassment injunction or protective order?

YES

NO

Question 5: *

Have you ever resigned, been terminated or been asked to resign from a position, whether paid or as a volunteer, due to a complaint(s) of sexual, physical or verbal abuse of minors?

YES

NO

Representations and Release *

I understand that Joy Meadows volunteers to agree to abide by policies and parameters established by the Joy Meadows Board, including strict policies against any form of child abuse, and that violation of these policies may be cause for dismissal. Child abuse is punishable by law, and Joy Meadows is bound by law to report allegations of abuse or any inappropriate sexual contact to the proper authorities. ALL reporting is kept confidential, by law. All volunteers must commit to immediately report any behavior that seems suspicious, questionable, abusive or inappropriate between: child-to-child, staff-to-child, and staff-to-staff. I understand that I may be required to submit to a background check as a condition of acceptance as a volunteer, and that unsatisfactory results, refusal to cooperate, or any attempt to affect the results of these background checks will result in me being removed as a volunteer or volunteer applicant. I hereby certify that all of the information provided by me in this Application (or in any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in these documents may (or will) be cause for the denial of acceptance as a volunteer, or immediate removal as a volunteer, regardless of the timing or circumstances of discovery. In consideration of the receipt and evaluation of this Application by Joy Meadows, I hereby authorize you to contact any references, churches, youth groups, former and present employers, charities, courts, and any other person, or organization that may have information about me, and for them to provide to you such information that they may have regarding my character and fitness for working with children. I hereby release any such entities or individuals who may have provided information about me from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I also agree to hold Joy Meadows, Joy Meadows Leadership, and any other person to whom the release above applies, harmless from any damages, specifically including attorney fees and court costs, related to information described above or any other unwarranted action by me in connection with this Application. I waive any right to inspect any information provided about me or by any person or organization identified by me in the Application process. I understand that submission of an application does not guarantee me acceptance as a volunteer. I further understand that should Joy Meadows extend an offer to me as a volunteer, it is for no specific duration and may be revoked by either Joy Meadows, or me at any time, with or without cause. If accepted as a volunteer, I agree to conform to the rules, regulations, policies, and procedures while serving as a volunteer, and understand that such compliance is a condition of remaining a volunteer. I have carefully read the above Application and this Acknowledgement and Release and know and understand its contents; I also know the above is legally binding on me. I sign this Application and Release of my own free will.

I agree