Last Name
First Name
Middle Initial
Home Address
City, State
Zip Code
Cell Phone
Work Phone
Email Address
Employer
Role/Title
Years
Spouse's Name
Children's Names and Ages
Grade Preference (Select One)
Elementary
Middle School
High School
Is there any medical information we need to know about?
Emergency Contact Name
Emergency Contact Number
Relationship
St. Ignatius Loyola Parishioner (Realm)#
Prior Religious/Parish Volunteer Experience
Prior Experience working with Children/Youth
Hobbies, interests, skills, talents, certifications
Why do you want to volunteer?
What are the strengths you bring to your role as a volunteer?
Have you ever been convicted/plead no contest to any criminal offense (misdemeanor or felony)? If yes, please explain:
References
I would like to volunteer in the following ministry (type in ministry below):
Please Accept and Sign below:
I hereby certify that the information I have provided in this application and any attached documents are complete, true, and correct to the best of my knowledge. I give permission for this information to be verified, if necessary, by contacting persons or organizations named in this application, or by contacting any person or organization that may have information concerning me. I hereby release and agree to hold harmless from liability any person or organization that provides information. I also agree that if any event occurs that would change the answers given above, I will report that immediately to the Director of Religious Education.
I understand that it is my responsibility to comply fully with the Safe Environment Requirements of the Diocese of Palm Beach. I understand that these requirements include at a minimum submitting a background check, fingerprinting, and completing the appropriate Safe Environment Training (VIRTUS) program. If at any time additional requirements are made by the Diocese or Parish, I will comply.
I agree to conduct myself in accordance with the Diocese of Palm Beach Code of Pastoral Conduct for Church Personnel. I agree to hold harmless the local parish, the Diocese of Palm Beach, and the oficers, employees, and volunteers thereof. I understand that I can be released from my volunteer service at any time and for any reason or for no reason. I understand that my service is of a volunteer nature, and I will not be paid or receive any compensation for my services.
Signature (Please Type)
Date
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