Reference Contact Form printable pdf download

Reference Contact Form

Reducing the risk of child sexual abuse: Guidlines for Parishes

REFERENCE CONTACT FORM

CONFIDENTIAL

Name of Applicant _____________________________________________________________

Reference or Church Contacted (if a church or other organization, please identify both the

church and organization and person contacted)

_______________________________________________________________________________

Date and Time of Contact ________________________________________________________

Person contacting the Reference or Church _________________________________________

Method of Contact (telephone, letter, personal conversation, etc.)

_______________________________________________________________________________

Summary of conversation ________________________________________________________

_______________________________________________________________________________

___________________________________

Signature

___________________________________

Position

___________________________________

Date

Reference Contact Form