WOMEN’S BIBLE STUDY / CA MOMS CHILDCARE APPLICATION

WBS/CA Moms Childcare Appplication

This form is to be completed by all applicants for any position involving the supervision or custody of minors. This is not an application for employment. It is used to help Christian Assembly Foursquare Church provide a safe and secure environment for children who participate in our programs, ministries, and for the use of our facilities. This application contains some questions that are personal in nature. Please be assured that sensitive information is kept confidential.

G E N E R A L

Name(Required)

First Last

Date of Birth(Required)

Email(Required)

Enter Email Confirm Email

Phone Number(Required)

Mother's Full Name(Required)

Father's Full Name(Required)

How long have you been consistently attending Christian Assembly? (If applicable)

R E F E R E N C E S

List two people you know who: 1) are over 18 years of age 2) are not related to you 3) have known you for more than one year 4) have, preferably, observed you with minors

1) Full Name (Reference 1)(Required)

Address(Required)

Phone Number(Required)

Email Address(Required)

Full Name (Reference 2)(Required)

Address(Required)

Phone Number(Required)

Email Address(Required)

Parent/Guardian Full Name

Parent/Guardian Phone Number