Youth Ministry Chaperone Application

Name: Email:

Address: City: St: Zip:

Home phone: Cell phone: Work phone:

Gender: Age: Marital status:

Children and ages:

Trinity UMC member? Y or N How long:

Do you have any experience in youth ministry? (If so briefly describe)

Are you willing to undergo a background check?

Is there anything you think the youth ministry steering committee should be aware of regarding your potential work as a chaperone of minors?

Youth Chaperone Application (continued)

Protecting our Kids and Integrity Affirmation Page

Cultivating a safe environment for youth and protecting the integrity of adult chaperones is not merely a good idea, it is fundamental to the quality and success of youth ministry at Trinity UMC.  Therefore the Youth Steering Committee consisting of parents, students, and other youth leaders adopted on September 22, 2003, the following guidelines of any volunteer chaperone.

1.  Every student must have a medical release form on file before leaving the church in the care of Trinity UMC. 

2.  Every student must have a completed permission slip signed by her or his parent and/or legal guardian specific to the off-sight event before leaving the church.

3. Adult chaperones must be willing to undergo background checks and have the support of the Youth Steering Committee.

4. Adult chaperones must not be alone with students or small groups of students at youth functions or during the time leading up to or following the event.

5. Adult chaperones should work with another adult not in his or her family at youth functions. 

6. Student behavior will be appropriately and reasonably monitored to make every effort to prevent sexual misconduct, physical injury, or emotional harassment.

7. Trinity youth leaders obey all federal and state laws, including traffic laws, as well as rules and policies of camps and other institutions with the knowledge that such will increase the likelihood of everyone's safety and enjoyment.

I have read, understand, and support these guidelines and will take all reasonable measures to abide within and enforce them where appropriate.

______________________________________ ___________________

(Signature) (Date)