Kid Country Helper 2012/2013


Welcome to Kid Country! Thank you so much for being willing to serve with the kids. We ask all helpers to fill out this form because we highly value the safety of the children who come to CrossPoint each week. Please fill out all the information and we'll get you plugged into a classroom. Thanks!

Qualifications: a Kid Country helper needs to be a member or a regular attendee of CrossPoint Community Church for at least six months OR have obtained permission to serve from a member of the pastoral staff.

Name

Address

City & Zip

Home Phone

Cell or Work Phone

E-mail

Occupation

Place of employment

Years at CrossPoint

Marital Status

Spouse's Name, if applicable

Name of small group leader, if applicable

Two personal references (over 18 and non-related):
Name & Phone

Name & Phone

Options for serving (select ONE of the two options)

Option One
Serve all Sundays in any three months
August 2012
September 2012
October 2012
November 2012
December 2012
January 2013
February 2013
March 2013
April 2013
May 2013
June 2013
July 2013
Whichever 3 months I'm needed most

Option Two
Serve one Sunday each month (plus one fifth Sunday)
First Sunday of each month, plus Sept 30
Second Sunday of each month, plus Dec 30
Third Sunday of each month, plus Mar 31
Fourth Sunday of each month, plus June 30
Whichever week I'm needed most

Option Three


Choose the service you'd like to serve:

Choose the age group you'd like to serve with:
Early Childhood (birth-35 mos)
Preschool (3 yrs-kindergarten)
Elementary (Grades 1-2)
Tweenage (Grades 3-5)
Bridges (special needs ministry)
Wherever Needed Most
I'd like to serve in my child's class
Child's Name

How would you like to be contacted regarding your classroom assignment?

(Don't forget to let us know if your addresses change)

Additional Comments?

Helper Statement:
The information above is correct to the best of my knowledge. I authorize any references or organizations to give information regarding my character or fitness for working with children and I release all such references from liability for any damages that may result from furnishing such information to CrossPoint Community Church, Modesto. I have never been convicted of a crime involving the actual or attempted abuse or molestation of a minor.
I agree

How God Works
group resources

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Kid Country Helpers 2012/2013
Influence the Future

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209.521.0181 | 1301 12th Street, Modesto, CA 95354 |info@cpmodesto.org