Children’s Worker Disclosure Form

F.A.I.T.H. Homeschool, Inc. — Child Abuse Prevention Program

Every worker in our sports and co-op programs must complete this disclosure form and be approved before serving with children. Please answer each question truthfully. Your responses are sent privately to the F.A.I.T.H. Director for review.

Please read the F.A.I.T.H. Child Abuse Prevention Guidelines for Workers in Children’s Ministries shown below before completing this form.

Child Abuse Prevention Guidelines for Workers in Children’s Ministries

Your Information

Disclosure Questions

1. During your lifetime, have you ever been convicted for an alleged incident of assault, domestic violence, child molestation, child abuse, child neglect, assault or sex offense of any nature?
2. Have you ever been convicted of a crime, other than a traffic offense?
3. Do you currently have any pending felony charges or pending felony arrests for any alleged incident involving assault, domestic violence, child abuse, child neglect, assault, molestation, or sex offense of any nature?
4. Have you ever previously been involved in any prior incidents in which you molested, abused, fondled or unlawfully assaulted a child?
5. Are you a Christian?
6. Have you read the FAITH Child Abuse Prevention Guidelines for Workers in Children’s Ministries and do you agree to abide by them?

Certification & Signature

Sign above using your mouse or finger.

Applicant is under 18 — a parent or legal guardian must also sign.

Parent/guardian signs above.

Background Check Release

Do you consent to a background/police check as described above?

Your date of birth and phone number above are used for the background check. Your signature above authorizes this release.

Typing and drawing your signature constitutes your electronic signature and has the same legal effect as a handwritten signature.