Form

Volunteer Application for Midtowne Student Ministry
This application is to be completed in full by all volunteers for any position involving the supervision, teaching, or custody of minors. Information will be treated as confidential and is needed to help us provide a safe environment for children and students who participate in our programs and use our facilities.
Name
Adress
Home Phone
Work Phone
Cell Phone
Email
SSN#
Birth date
Drivers License #
Marital Status
Spouse's Name
Emergency Contact
Emergency Contact #
Positions: In which areas would you like to serve? Please check below.
Age Groups

Middle School (6-7th) Junior High (8-9th) High School (10-12th)
When are you Available

Wed Night Worship Sunday Worship Midweek Small Groups
Enter the word you see*
Should be Empty:

Volunteer Application for Midtowne Student Ministry