Thank you for your interest in becoming an Exilic Kids volunteer at Exilic Presbyterian Church. The following is an application form we ask all volunteers to fill out. We understand that some of the questions are of a personal nature, but the children at Exilic are important. It is important that we know who is caring for them. The information contained in this application will be disclosed only to those who have a genuine need to know in order to carry out their responsibilities for Exilic Presbyterian Church, or as required by law. 

General Information
Name *
Birthdate *
Phone *
Address *
Are you currently certified in CPR or First Aid? *
Personal History
Health *
Do you have any health problems (disabilities, physical limitations, etc.) that might affect your work with children?
Addictions *
Have you ever had a problem with drugs, alcohol, pornography, or any other addiction, or, has anyone ever suggested that you may have a problem with any of these things?
Arrest Record *
Do you have an arrest record?
Child Abuse *
Have you ever been convicted or accused of physical abuse, sexual abuse, neglect, molestation, or exploitation of a minor?
Ministry information
Are you a member of Exilic Presbyterian Church? *
Are you currently serving in another church ministry?
Check all that apply:
List names of churches or organizations, duties, age group/grades, dates, etc.
personal references
Reference # 1 *
Reference # 1
Phone *
Reference # 2 *
Reference # 2
Phone 2 *
Phone 2
Should this application be accepted, I agree to be bound by the bylaws, doctrines, and policies of Exilic Presbyterian Church and to refrain from unscriptural conduct in the performance of any services on behalf of this church. If, at any time, I am out of accord with any of these, I agree to withdraw or be withdrawn from my position. This information contained in the Exilic Kids Volunteer Application is correct to the best of my knowledge. *