This form must be filled out and submitted as part of the Safe Church Training process to be approved to work with children and/or youth at Beacon Heights Church of the Brethren.

Please list two character references (other than relatives).  These references will be contacted via email.

I recognize that the organization to which this application is being submitted is relying on the accuracy of the information contained herein.  Accordingly, I attest and affirm that all of the information that I have provided is absolutely true and correct.  

I authorize the organization to contact any person or entity listed in this application, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications.  

I voluntary release the organization any such person or entity listed herein from liability involving the communication of information relating to my background or qualifications.

I authorize this organization to request a background check.

I have carefully read the policy and procedures of the organization, and I agree to abide by them and to protect the health and safety of the children or youth at all times.  

I agree to attend Safe Church Training and to keep my training renewed every five years as long as I wish to remain in contact with children or youth at this organization.