Name
*
First Name
Last Name
Email Address
*
Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Gender
*
Male
Female
Date of Birth
*
MM
DD
YYYY
Ages of Children
What church do you attend?
*
Pastor's Name
*
Pastor's Phone Number
(###)
###
####
In what ministry areas are you involved in your local church?
*
Briefly tell us how you came to know Jesus as your Lord and Savior:
*
Describe your current devotional life:
Do you currently struggle with any addictions such as alcohol, drugs, tobacco, or sexuality? Please explain:
Why would you like to be a volunteer with Lighthouse Xtreme?
*
I would be interested in helping out with these areas at club:
Please list any background you have in mentoring children:
What life experiences do you feel have prepared you to be a mentor?
What is your current vocation?
Special Skills/ Talents, Interests and Hobbies
Service Category
*
Volunteer
Community Service for School Credit
What is your availability of time?
*
Evening
Daytime
Days of Availability
*
Day Preferred
*
Would you be willing to drive children?
*
Yes
No
Maybe, Please Give me More Info.
Do you have any physical limitations?
Please List 2 References Not Related to you:
*
First Name
Last Name
Reference 1 Phone Number
*
(###)
###
####
Reference 2
*
First Name
Last Name
Reference 2 Phone Number
*
(###)
###
####
Whom should we contact in case of an emergency?
*
First Name
Last Name
Emergency Contact 1 Phone Number
*
(###)
###
####
Relationship
*
Emergency Contact 2
*
First Name
Last Name
Relationship
*
Emergency Contact 2 Phone Number
*
(###)
###
####
I hereby allow Lighthouse Ministries, Inc. to perform background checks if needed for volunteering:
*
