KidsWorld

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KidsWorld

Visitor Agreement This is NOT an application to serve.

YOU MUST COMPLETE BOTH SIDES OF THIS AGREEMENT PERSONAL INFORMATION The information contained in this application will be kept confidential. It will be disclosed only to those who have a genuine need to know in order to carry out their responsibilities at Christ Community Church, or as required by law. 1. Today’s Date

What KidsWorld room are you visiting?

Last Name

First

Street Address

Gender

MALE

FEMALE

Apartment/Unit #

City

State

Home Phone

Cell Phone

ZIP

Email Other names you may have used (first & last) Emergency Contact Name & Phone 2.

NOW FOR SOME PERSONAL QUESTIONS

Have you ever been accused of or charged with neglecting, abusing, molesting or battering any child or adult? No

Yes

If yes, please explain: _______________________________________________________________

__________________________________________________________________________________________________ Do you have a contagious or infectious disease or condition, which could be transmitted to others in the room you will be visiting? No

Yes

If yes, please explain: _______________________________________________________________

________________________________________________________________________________________________

3.

VISITOR/OBSERVER AGREEMENT

Please initial the following statement that best describes your visit:

o o o · ·

I am the Parent/Guardian of ___________________________. I understand that while my child is in KidsWorld, I am required to have a second adult with me at all times even with my own child. I am the guest of _________________________ who is serving in __________________________. I am a visitor from ____________________________________. I am here to observe KidsWorld at Christ Community Church.

Please read the reverse side in full. Your printed name, date, and signature are required to receive a visitor’s badge. Please return the visitor’s badge to Guest Central at the end of service.

Revised 09/16/2013

Christ Community Church 1

KidsWorld

Visitor Agreement

I understand that I am here to observe. At this time I am not a fully approved volunteer but I must still follow the KidsWorld policies set forth in the following agreement: Our Child Protection Policy is designed to protect both children and adults by not giving opportunities for adults to have sustained time alone with a child or student. ·

I understand that I must fill out this form each time I observe or visit KidsWorld at Christ Community Church.

·

I understand that I must wear a VISITOR badge if I am in KidsWorld at Christ Community Church during services.

·

I will not allow myself to be alone with a child, even if he/she is my own, once checked into KidsWorld.

·

As an observer, I will not accompany a leader to the bathroom or change a diaper in the nursery.

·

I understand that I may only use the bathroom located at Guest central during services.

·

I will follow all directions given by Christ Community Church KidsWorld staff and volunteers during my visit.

·

I understand that visiting KidsWorld at Christ Community Church is a privilege. If I fail to comply with the guidelines set forth above, I will be asked to leave.

·

If I wish to serve, I will fill out a full application at Guest Central.

________________________________

______________

Printed Name

Date

________________________________

______________

Signature

Badge Number

Revised 09/16/2013

Christ Community Church 2