Oregon Conference Volunteer Ministry Information Form

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Oregon Conference Volunteer Ministry Information Form
19800 Oatfield Rd. Gladstone, OR 97027
*** OFFICE USE ONLY***
Recommended:
Not Recommended:
Recommended with Caution:
Date Received:
Comments:
Renewal Date:
Date Approved:
Signature of Conference Director:
Please check all that apply:
Primary location of volunteer activity (church/school)
Adventurers
Education/Schools
Camp Meeting
Pathfinders
Vacation Bible School
Children’s Ministries
Other
Church Office(s)
Print Legal Name:
Last
First
Initial
List all other names/aliases used by you:
Street Address (No P.O. Box):
City
State
Zip
Home Phone number:
Work Phone or Cell Phone number:
Email Address:
Are you a member of the Seventh-day Adventist Church?
YES
NO
(If no, skip to the next section)
(Please circle)
How long? __________Mos. __________Yrs.
The name of the Adventist church you now attend:
If you have been in your current church for less than 5 yrs, please give the name of your previous church home(s):
Name of church:__________________________________________ City_________________________________ State ______________
Name of church:__________________________________________ City_________________________________ State ______________
If you answered “no” to the previous question, please respond to the following: Have you been known by the local church or
school for at least 6 months? * ( Please circle)
YES
NO
If you have not been known by the local church or
school for at least 6 months, when did (will) your relationship with the local school or church begin? (interview to enroll child in
school, start of school year, regular attendance at church, etc.) __________________ (Month/Year)
*There is a waiting period of at least 6 months before you are eligible to volunteer.
List below: (a) your pastor and (b) two individuals (other than family members) who have known you for at least 3 years and who
could recommend you for service with children. The Conference may contact additional references if the individual you list is
unavailable, unable to provide a reference, or if otherwise needed.
References
Your Pastor
Street Address
City
Zip
Phone or Cell Phone#:
1.
Area Code (
)
-
Name
Phone or Cell Phone#:
2.
Area Code (
)
-
Name
Phone or Cell Phone#:
3.
Area Code (
)
-
Rev. 2/2012

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