BOOMIN’ MINISTRIES PACKET OF INFORMATION:

Our reason: “ You are the light of the world –like a city on a hilltop that cannot be hidden.” –

Matthew 5: 14Boomin’ Ministries is a collective fellowship of a families’ ministry that helps provide families with a fun, safe worshiping experience to connect with God.

WHAT BOOM’N IS NOT…• It is not a Sunday “school”

• It is not a baby sitting service• It is not a set of explosives

WHAT IS IT THEN? • It is a Children Based Ministry

– Meaning that we work around what makes a kid a “KID”, we teach them meeting their needs (for example if they are runners let them run, if they are hyper let them be hyper, etc). We are here to meet your kids needs and show them the gospel in the way best suited for them.

– It is a fun-safe environment where kids can grow in their faith and learn their personal connection with God.

WHAT DOES BOOM’N MEAN?• BOOM’N is the family ministry with the outlook to grow and -exploding

in outreach!

Our Vision: To promote freedom to get away from “church-yness” and “religion” and provide families with close interaction with God in new fun-filled ways. We target families and hope to grow both kids and parents in their walks with Christ. We will use captivating creativity combined with individualized callings to create an awesome program away from standard educational programs. We are not a church building Sunday school, but a group of people hungry for God.

Objective Goals / Visions for each age group

Nursery age

The role of the earliest stage in childhood development ministry is to provide a safe, loving and care oriented environment for both the infant as well as his/her guardians. The key is to minister to the new family as a whole ( or to the growing family) rather than just to be a care taker for the parent while they are in Church of the Savior United Methodist.

Objectives-• Safe and peaceful environments

o A safe and clean facility with calm colors, lighting and open viewing living spaces. Have safe and fun toys for the child to experiment with the world (toys not just fun but educational geared for the starting developmental stages of the child).

o The parent should also be able to be buzzed if having a problem. Parents should also have the ability to card to card (child and parent) to be able to check up or pick up the child for safety and reassurance (that is essential) to both the church and the ultimately the guardian. Children should not be picked up nor looked at without the identification card.

o The personnel must be equip to handle any situation while at the same time can present themselves as calm collective and well managed in the position. This is not a babysitting service, rather this is a ministry and thus they must have certain beliefs as well as care skills. Personal skills, spiritual identity and growth, as well as active church participation is needed for this volunteer position.

Toddler ages

This is the stage in the child’s life that is at its peek in exploration. In this part of their lives the students are beginning to realize that they create their own actions, and are growing both physically and mentally developing an independent nature. Because of this sort of growing thinking patterns, experience and building their imagination is the essential key that we as a ministry can give to these special ages. Using their senses, they wonder, and laugh and are some of the care-free happy people on the planet! This is the best stage to start teaching God’s love –the ministry in this stage goal’s to provide not only a safe and pleasing environment, but also a fun, interesting and curious one too. This like the previous one must be handled with care, but also must have attributes to handle the child’s desires to explore this new and interesting world. Let this stage of our ministry here at Boomin’ be one full of non-stop fun and tangential-target-able things for teach child to build their own world discovering everything that the Lord has given to them.

Objectives- • Peaceful exploration, but Moral foundational

o This ministry needs to create a safe, but filled with attractive sense-orientated lessons. Tactical and object lessons are the primary teaching styles that must be included. This is not a babysitting service, but a fun interactions as these kids are given their first moments experiencing all of God’s wonders! They are not quiet yet at the mental capacity to learn fully of God’s word and teachings, but they are in the first amazing stages in which they can truly experience His world and love. It is our jobs in the ministry to give special attention to the foundational first steps in faith with providing them simple lessons that will get across the message of God’s love and Jesus. If this is the primary objective then throughout this process let it be the ONLY objective.

o This is the key point in their lives where imagination starts to take hold of a child and thus symbolism. Joined with the feelings and new sense of perception, imagination emerges as one of the top tools for our faith lessons, and will continue as the building blocks throughout a lifetime. The child’s understanding of God is based off of here and takes shape around the emotional experiences each child has in this stage, and thus it’s essential that the lessons are guided around putting a positive influence on the child. Specific care must be given to each child as well as the group as an emotional front.

Preschool

This is an important stage when state education begins, and where the church education should also take hold: In this early stage the students learn in school the mannerisms of what a student’s autonomy will be like for the continued education throughout all 12 grades as well as the extending education. As such the church has to combine the rules of the school in order to help the child set the concrete foundation of God’s word. With an increased capacity for taking responsibility for oneself its imperative that this stage helps the students take a look within to promote their outlook on life and where they stand in it as well as their environment with both the subject of rewards and punishment. (first stage to bring in lucky seat system). It is a stage for learning and grasping their levels of mental strengths.

Objectives- • To create a school like system and teach the foundations

of good behavior, rewards/punishments and authoritative positions without taking away that same ministry foundation of Boomin’: Fun! Thus these systems must not be evident to the child –if they are above the aspect #1 rule of fun then we are going to far and must be subliminal. This is a great stage for starting to teach God’s word, but it can’t be over developed in red tape. So as a volunteer teach with joy, but teach within the confides of the system that they learn in their lives outside of church.

• To have joy of ALL stages of time of learning: free time, craft time, snack time, story time (lesson), etc.

• To promote the students by giving them a great self esteem and “building up…not tearing down”. The staff must have a positive emotional outlook when in the classroom and in the church. They will look to the teachers to know how to know and love God.

• Love is the primary theme that has to be expressed. These children must experience love and special attention to grow the self confidence and faith value, “Jesus love me”. If there is one thing I hold dear to my heart it’s that out of all the rooms one should hear one thing present: laughter. There must be joy and learning has to turn into something fun.

• In this stage faith experience have an episodic quality; they are a collection of independent, generally unconnected events. Therefore, it’s good that each lesson should have all of the above. Rewards should be given often, and punishments (although presented with a real firm existence) must be limited and rare.

Kindergarten and beginning stages of 1rst grade

In this early childhood stage the child should emerge from the joy oriented school-based program and should already have a lesson foundation (basic and simplistic); now comes the primary adaptation stage where they combine what are the basics to what they will learn as the building blocks. It’s the stage where a child now begins to take the foundation and build upon it, going throughout the bible stories. The essences of the stage is build up the knowledge of the bible and learn “the book smarts” of the bible.

Objectives-• Going through and helping each student learn scripture.

This is an important stage to educate the student and help them get familiar with the stories of scripture. Bible stories and biblical characters can come into their lives as tagitable linear lesson-oriented foundation now. Students can start to mesmerize and be taught until it’s rooted down into their hearts the key lessons of scripture (creation, God’s love, 10 commandments, gospel, nativity story, Great commission, Jesus’ resurrection; etc.).

• At this stage they are beginning to grasp the mental desire to manipulate objectives and learn how things work (they are not there yet fully, but they are starting to explore this mental capacity). The task is to develop a capacity for motivation to learn while trying to avoid an excessive sense of inferiority which will shut the student down and turn them away from wanting to learn more: “I’m a bad student, I can’t do this, its too hard” VS “I love this, Yeah!, its fun!, tell me more”.

• To hold true to the Boomin’ principles of laughter and fun! Let this stage be a “different” look to the scripture stories. Games are a great time here and don’t be afraid to make up them. Crafts too are a great way to learn.

• Also this is the stage to start presenting them to Parent’s Date Nights, and similar outreaches where they can meet kids and laugh and play. Remember kids often cry when their parents leave them --our goal is to have them cry when the parents need to leave! If a kid wants to stay at a setting where the Lord is so evident then that is the greatest example of the true ministry.

1-5 graders

This is the heart of childhood! The middle grounds where children now understand the gospel, realize who they are and what they like/dislike, and what they don’t know. They have tons of questions, and now is the heart of answering them! This is where the BOOMIN’ room takes its safe haven: fun exploding through the walls. Developed habits of how a Christian is, needs to start to form by biblical teachings and lessons oriented around games. This is the shift from school education to lifestyle. We are not a classroom here, rather an engaged environment. The students have some degree of independence for which they can learn the talents they have and nurture them. The goal in this age is to raise up Christians and teach them the foundations of discipleship by having them learn in the best way a kid can be a kid. Watch Disney, Nickelodeon, Cartoon Network –see how each presence fun in a Blasting way. That same teaching style can be brought down to the Church of the Savior in these classes to teach biblical messages. The primary goal is to convert what was thought as one a summer (VBS style) and learn how to switch that successful learning style to an all year round event. Worship! Play! And Learn!

Objectives- • A deeper (age appropriate) understanding of scripture• Introduction to the lifestyle of a discipleship • Develop talents and skill set that the Lord gave them.• An understanding of worship, evangelism, outreach, discipleship,

understanding of baptism, habit of prayer, communion, and a confirmed personal relationship with Christ.

• A breakdown of literalism that leads to the child’s faith oriented studies into a more critical understanding of Christ and how faith is the “real world”.

• Moving with that lifestyle with working on using what is learned inside the class in everyday life, mesmerizing biblical passages to help one another, to learn to read the bible effectively, and help bring friends to church that might not otherwise go.

6-7th graders

This is the final stage, but the most critical before they go on to the regular Church of the Savior services. In this stage the students take the key objectives and philosophy ideology learned over the years and combine ALL of what they have learned and continue to learn in order to help convert that into serving the lord in their own way. As a ministry we have to help them learn how to make that faith of theirs into their own way by helping them as disciples on a 1 on 1 basis. Helping them learn how to become servants and where to go in life is essential as we teach leadership and start to plug them into volunteer settings in and outside of the classroom. Confidence is critical to keep up in this stage and to discipleship way to express their faith. Questions will be brought up and must be answered, but all at the students individual speed.

Objectives- • To learn how to use what they’ve learned and become more

of a volunteer status.• To help them learn their vocation through experiments.

This is a surface level stage used to experiment how they can work for God in the world. How they can show Jesus in their culture/ community and how they can learn through mentors (set them up with prayer partners and mentor systems)

• To make their faith their own by helping them guide through discipleship as well as still learning the lessons of Boomin’ with the other students, but then focus on them and ask, “Why” or have them help with the lessons.

• To help understand the family of Christ and how to help their own families with Christianity.

• To start to learn the traditions in the church and start to move them (7th grade only) into learning the adult/teen ministry at the adult services in order to fundamentally get them ready for the next year.

Safety policies at Church of the Savior“People were bringing little children to him in order that he might touch them; and the disciples spoke sternly to them. But when Jesus saw this, he was indignant and said to them, ‘Let the little children come to me; do not stop them; for it is to such as these that the kingdom of God belongs.” Mark 10: 13-14

-as a part of what Boomin’ ministry is, we are bound to bring little children and help not to hinder them in anyway nor to let others do so.

Reducing the Risk of Child abuse in the Church of the Savior

Tragically we live in a fallen world, and churches have not always been a safe place for kids to come and know Christ. Children are abused in a number of churches all over the country of all shapes and sizes, urban and rural each year. Such incidents are devastating to everyone involved: the abused child, the family of that child, the local church, the local community, as well as the church as a whole --kingdom of heaven. Increasingly churches have been torn apart by the legal, emotional toils of litigation following allegations of abuse. God calls us all to make our church safe by protecting everyone involved within each and every way we can. Come let us rejoice together and learn how as a group we can stand strong against any trouble the devil tries to through at us and help us benefit the kingdom of heaven by keeping our children safe.

The Social Principles of the UMC states that, “…children must be protected from economic, physical, and sexual exploitation and abuse.” The last thing this ministry wants is for a child to be exploited by anyone for any reason. It is for this reason that the purpose of these child protection policy will be in affect. As a whole we hope to accomplish by these terms are:

1. Provide a specifically designed system of protection for both our children, as well as our staff.

2. To establish an appropriate way of responding to alleged, reported, or suspected incidents of abuse while in Church of the Savior United Methodist.

3. Be in a compassionate ministry with all affected persons –the alleged victim, the alleged victim’s family (and help support to), the alleged victimizer and the entire church family.

We hereby wish to state these policies in order to put them into practice effective immediately with the intent to:

1. Safeguard all the children of Boomin’ Ministry from abuse of any kind.

2. Respond to all allegations in a fair, compassionate and Christ-like manner.

3. To help protect the church staff and volunteers from potential false allegations of abuse.

4. Limit the extent of our church’s legal risk and liability.5. To strengthen our Christian educational ministry: Boomin’

Ministries.

Definition: *It should be noted that we are using Ohio Law to define abuse. Using other

definitions could cause the Church of the Savior United Methodist Boomin’ Ministry to be liable for acts which would not normally be covered by Ohio Law. In other words, expanding the definition of abuse in the policy may also expand the liability.

Child abuse is defined in accordance with Ohio law. 1. Engaging in any sexual activity with a child, as defined under Chapter 2907 of the

Ohio Revised code; or 2. Endangering a child, as defined in Section 2919.22 of the Ohio Revised Code

(this law defines “Child endangerment” to include any of the following: 1- abuse; or 2-torture or cruel abuse; or 3-corporal punishment or other physical discipline such as spankings or prolonged cruel restraint, which is excessive under the circumstances, and which could likely physically injure the child; or 4-repeated, uncalled for discipline which, if continued, would seriously impair the child’s mental health or development; or 5- involving the child in any obscene, sexually-oriented, or nudity-oriented activity or conduct); or

3. Denial, as a means of punishment, of proper necessary subsistence, education, medical care, or other care necessary to a child for the child’s health; or

4. Use of restraint procedures on a child that cause injury or pain; or 5. Administration of prescription drugs to a child without the written approval or

ongoing supervision of a licensed physician; or6. Providing alcohol beverages or controlled substances to a child; or7. Commission of any intentional act that results in injury or death to a child; or 8. Infliction of physical or mental injury that threatens to harm a child’s health,

welfare, or safety.

Policies for the classroom supervision

Here at Boomin’ Ministries we hope to be able to bless the children with all that God has to offer them. It is because of that that we have a set system that will protect them from all that the definition above has previously stated along with helping keep the volunteers safe from legal harm.

Boomin’ safety during church services

• At least 1 adult present in classroom at all times; with at least 1 individual (our security guard) giving random routine checks involving being aware of the children in the room as well as the whereabouts of the other staff or children whom might not be present in the room. (this 1 adult does not count youth

workers who must also be present with an adult supervisor that may be the 1 adult present).

• We at Boomin’ Ministry hold an OPEN DOOR POLICY which means that all classroom doors will remain open and parents (with cards), screened –volunteers, or staff are allowed to visit and observe the program at any time.

• Attendance will be recorded of each child’s entrance; if a child needs to leave early they can as long as accompanied by the accepted parent. At the end of the service children are not permitted to leave unless accompanied by the picked up parent.

• Record of child: We at Boomin’ ministry believe the importance of keeping digital emergency records kept by the church children’s director and hard copy locked in the church office. THIS WILL NOT BE DISTRIBUTED.

• CARDS: Identification cards will be in affect. Each card will have a picture identification, age, service in which attends, and regular picked up name. A copy will go out to the person who dropped him/her off. In order to pick up said child at the end of the service or to see that child in-between services is to give the correct card copy. Under all circumstances, the supervisor is expected to exercise his/her best judgment and in case of insecurity to immediately contact staff member/ security.

o The Parents or guardian’s copy shall follow: parent or other identified adults responsible for the children who are under the ages of 13, will be given matching numbered name tag cards. One tag with the child’s name, age, service, and picture; the other with the adult’s picture identification, name, service and number of children allotted to pick up. The parent will keep the other tag and will return it when he/she picks up the child. Children will only be permitted to leave with the parent in possession of the tag or with the responsible party whom the parent entrusted with the tag.

Boomin’ Ministry outreach events safety

• At least 2 adults; 1 male and 1 female who are at least 18 years of age and at least five years older than children. with at least 1 individual (our security guard) giving random routine checks involving being aware of the children in the room as well as the whereabouts of the other staff or children whom might not be present in the room. (this 1 adult does not count youth workers who must also be present with an adult supervisor that may be the 1 adult present).

• We at Boomin’ Ministry hold an OPEN DOOR POLICY which means that all classroom doors will remain open and parents (with cards), screened –volunteers, or staff are allowed to visit and observe the program at any time.

• Record of child: We at Boomin’ ministry believe the importance of keeping digital emergency records kept by the church children’s director and hard copy locked in the church office. THIS WILL NOT BE DISTRIBUTED.

• Parents are supposed to turn a written signature in a sign-in / sign-out procedure in order to state if the child did in fact be dropped off and picked up (early or otherwise).

• At the beginning as parents are dropping off child please have a written form showing parents which rooms will be used. Any rooms not listed (at the awareness of the church staff) will not be permitted to be used during the outreach.

• If any child becomes ill or injured during the event, there is an impedance response to call the parental guardian and request them to pick the child up. An incident report will be filed and a copy made for the parental guardians.

Overnight (or otherwise) Retreats and Transportation in safety

• There shall be at least three adults present for all trips, retreats, and other times’ children and or youth gathers at or away from the Church of the Savior United Methodist building.

• If any child becomes ill or injured during the event, there is an impedance response to call the parental guardian and request them to pick the child up. An incident report will be filed and a copy made for the parental guardians.

• There shall be a permission including emergency medical care that shall be carried by the persons in charge of each trip/ and or retreat an accessible at any moment as needed. (see forms part of packet)

• In overnight situations (such as camp or otherwise), no adult are permitted to stay alone in a specific room with the children/youth. In those circumstances where adults are not staying in the rooms with children/youth. Special measures shall be taken to assure the children’s safety and supervision by having hall monitors, and periodic room checks by two adults of the same gender as those being checked. Parents will be made aware of such housing accommodations.

• At any retreat parents should be aware of where the child is, is going and what they will be doing at said event, before event takes place.

• Rules for providing transportation:

o The supervising adult must know drivero Driver must be 21 years of age

o Driver must have a valid state driver’s licensed and a hard copy documented in the Church of the Savior.

o Driver must have proof of insurance.o Driver must be accompanied by two children or youth, or have the consent

of the parental guardians if the driver will be transporting only one child/youth

o Driver must comply with all traffic lawso A screening background must be done of the drivero Drivers must require all passengers, including himself/herself, to wear

seatbelts and appropriate child retention devices at all times.o No alcoholic beverages will be consumed at any time by the driver or

passengers. o The driver must acknowledge and sign a statement understanding these

rules as well as the safety packet’s core beliefs of safety.

Incidents and Accident Reports

In order to assure the proper attention was given to an injure or accident, an incident report must be completed by the adult supervisor within 24 hours of the incident whenever a child is injured.

Response by Church Workers to Allegations of Abuse

The Boomin’ church ministry is a part of the church as a whole, and the Church is entrusted to provide an emotionally safe, spiritually grounded, healthy environment for families: the children, the youth, and the adults in which they are protected from abuse. It is our legal and moral responsibility to report suspected abuse whenever it comes to our attention regardless of where that abuse takes place. We will report suspected abuse to stop potentially existing abuse and prevent further abuse. To report abuse is a way that we can witness to the world of the love and justice of God. Reporting abuse is a form of ministering to the needs of those that are crying out desperately for Christ’s help. If an abuse occurs, it is our intention to act as an advocate for all the affected person involved, providing support, information, assistance and intervention. We always must seek to provide a supportive atmosphere, offering both objectivity and empathy as we seek to create a climate in which healing can start to take place. If any abuse is suspected by, observed by, or disclosed to a volunteer and/or paid staff member of the church, that person should report the incident immediately to the pastor. (If the accused is the pastor, children’s director, or paid volunteer then the following information below will need to be taken under) Be prepared to do the following, and many steps should be done simultaneously.

• IMMEDIATELY notify the proper authorities (children services board, the county department of human services exercising the children services function or a local law enforcement agency in the county in which the child resides or in

which the suspected abuse occurred.) THIS IS A REQUIREMENT OF THE LAW (Reference section 2151.421 of the Ohio Revised Code.) Do not attempt an investigation, as this should be left to the professionals who are familiar with these cases.

• Simultaneously notify the parents of the victim and take whatever steps are necessary to assure the safety of the child until the parents arrive. It is important to emphasize that the proper authorities must be notified even if the parent(s) does not wish the incident to be reported.

• If one or both parents are the alleged abusers then contact the proper authorities an follow their advise about notifications of the parents.

• Take any allegations seriously and reach out to the victim and the victim’s family showing care and support to help to prevent further hurt. This is an important time for the church family come together and help support the healing of this hurting family. As a Pastoral staff it is our duty to give any resources that might be helpful or needed, remembering that the care and safety of the victim is the first priority. Respond in a positive and supportive manner to the alleged victim and his/her family.

• After having reported the suspected abuse to the proper authorities, the incident is to be reported immediately to the church’s attorney, the church’s insurance company, and the district superintendent. The district superintendent will report the allegations to the bishop’s office. Do not try to handle this without the professional assistance. If the accused is a clergy member of the annual conference, local pastor, or diaconal minister, then provisions of Paragraph 358 and Paragraphs 2623-2629 of the Book of Discipline of the United Methodist Church must be followed.

• A written report of the basic information shall be kept to ensure on-going ministry to, and advocacy for, victims and others involved. A form for this purpose shall be available in the church office (see packet forms). The report shall be brief and contain only factual information relevant to the situation. It shall be filed in a secure place in order to ensure confidentiality and it should be written as typed to prevent it from being changed. The church must also file a copy of the report with the bishop’s office of the East Ohio Conference, where it shall remain confidential.

• Immediately, but with respect to the dignity sacredly worth of the accused, remove them from further involvement with children and/or youth. Only after the previous list has been completed can the leading pastor of Church of the Savior may tell the accused that the report has been made. If the accused is a volunteer or paid staff of the church, that person shall be relieved temporarily of his or her duties until the investigation is finished. If the accused is a paid staff person of the

church, arrangements should be made to either maintain or suspend his or her income until the allegations are cleared or substantiated.

• Any contact with the media should be handled with a pre-determined spokesperson. Care will be taken to safeguard the privacy and confidentiality of all involved. The spokesperson should generally convey that the matter is under investigation and any comments made prior to the conclusion of the investigation would be premature. If there was no pre-determined spokesperson then it falls upon the leading pastor to take these duties.

Protecting Workers

This policy must be red and signed along with all above in order for all Church of the Savior United Methodist staff as well as volunteer who are interacting with the Boomin’ ministries and (or) kids based ministry. This packet of procedures will be handed out to all parents as well. This policy and the procedures will be reviewed and distributed at least once per year. It is the understanding of the church staff that one that will work with the children ministries have been updated to this packet and trained on its information.

The church shall provide once a year a regular scheduled training focused on the issue of child protection (which will be an overview of this packet), training on the focus of this ministry and ways of ministry/ proper handling of situations with the interactions of the children. Attendance at this training is required for all who will have direct contact with the children or youth in the church ministry.

Training will include: 1. The definition and recognition of abuse2. Church’s polices on reporting abuse and use of appropriate forms3. The purposes of the policy as protection for the children and for the workers4. The meaning and importance of confidentiality5. The maintenance of a positive learning class environment, including the

appropriate rewards/discipline structure, the achievement goals, and new ways of educating messages effectively to the children

6. The appropriate behavior for teachers and leaders (both educationally as well as spiritually).

Training sessions will be handled by either the Director of Boomin’ Ministries, or a lay person responsible for the ministry.

Training will also include before allowed to work with kids alone: • BCI checks / YMCA care safety training • Personal screening record filled out• Interview with Boomin’ Director or lay person responsible for the ministry

• Signed copy of the packetACKNOWLEDGEMENT BY PERSONS DESIGNATED TO PROVIDE TRANSPORTATION TO OR FROM CHURCH EVENTS FOR CHURCH OF THE SAVIOR UNITED METHODIST

Are you at least 21 years old? __ Do you have a valid driver’s license? ___

Driver’s License #: __________________

Insurance Company _________________ Policy Number: _____________

Full Name: ________________________________________

Address: ______________________________________

Phone #: __________________________ Cell #:____________________

Birthday: _________________ Age: _____________

As required by Church of the Savior United Methodist Child Protection

Policy and Procedures, I acknowledge that I have read and will abide by the

terms staged in said policy. I hereby authorize the Church of the Savior

United Methodist to obtain a motor vehicle report by the state BMV. I

understand that copies of my Drivers License and proof of insurance will be

kept on file with Church of the Savior United Methodist.

Signature of Driver: __________________________________________

Date: ____________________

CHURCH OF THE SAVIOR UNITED METHODIST APPLICATION TO WORK

WITH CHILDREN AND/ OR YOUTH

All pages of this application are to be completed by all persons who desire to work with children or youth in our church’s ministry, or any other Boomin’ Ministries affiliated programs. The following must be filled out and handed in with the signed copy of the packet. This application is being used to help the church provide a safe and secure environment for those children and youth who participate in our programs and for those that work with them.

PERSONAL DATA

Date: ____________ Social security #: _______________

Full Name: ___________________________________________

Present Address: __________________________________________

City:_________________ State: ________________ Zip: __________

Home phone: __________________ Cell #: ____________________

How long have you lived at the above address? ________ year(s)

If less than a year, provide ALL addresses for the past five years:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Please indicate the type of age group you are planning on working with:

Why do you want to serve in this position?

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Please indicate the date you would be available to begin, and dates

specifically that you would not be able to commit to:

_____________________________________________________________

_____________________________________________________________

Our church has an open door policy which is stated in the protection

portions of the policies, are you comfortable with this atmosphere?

_____________

Our church encourages the use of two teachers or leaders for all children and

youth activates. Are you comfortable with team teaching?______________

Have you ever been charged with, convicted of, or pleaded guilty or no

contest to a crime against children or other persons? ________ (if yes please

explain)_______________________________________________________

_____________________________________________________________

_____________________________________________________________

CHURCH HISTORY AND PRIOR WORK

WITH CHILDREN OR YOUTH

How long have you been attending this church? ________________

How long have you been attending any other Christian church? _______

Please list any other the names of churches you have attended regularly

during the past five years (addresses if you can):

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

List all previous church work involving children and or youth (list each

church’s name and address, type of work performed, and dates)

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

List any gifts, talents, callings, training, education or other factors that have

prepared you for working with children or youth:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

REFERENCES

Please list three persons who have known you for at least three years and

you are familiar with your character, particularly as it relates to supervision

of children and youth. None of the references may be a relative.

Name: _______________________________________________________Address:______________________________________________________Daytime phone: ______________________ evening #: ___________________Length of time you have known reference:_______________________________Relationship to reference____________________________________________

Name: _______________________________________________________Address:______________________________________________________Daytime phone: ______________________ evening #: ___________________Length of time you have known reference:_______________________________Relationship to reference____________________________________________

Name: _______________________________________________________Address:______________________________________________________Daytime phone: ______________________ evening #: ___________________Length of time you have known reference:_______________________________Relationship to reference____________________________________________

WRITTEN RECORD OF CONTACT WITH A REFERENCE OF AN

APPLICANT FOR CHILDREN/ YOUTH WORKER: (CONFIDENTAIL)

Name of Applicant: __________________________________________

Individual, church or organization contacted:

____________________________________________________________

Method of contact: ______________________________

Summery of contact (summarize the reference’s remarks concerning the

applicant’s fitness and suitability for children):

_____________________________________________________________

_____________________________________________________________

____________________________________________________________

Signature:___________________________________

Position:______________________________ Date:_______________

APPLICANT’S AUTHORIZATION AND RELEASE

The information contained in this application is correct and complete to the best of my knowledge. I authorize Church of the Savior United Methodist to conduct a criminal background check (using BCI checks) and to check my driving record with the BMV. I authorize any references or churches listed in this application to give you any information, including opinions, that they may have regarding my character and fitness for work with children and youth. In consideration of the receipt and evaluation of this application by Church of the Savior United Methodist, I herby release any individual, church, youth organizations, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which my at any time result to me, my heirs, or family on account of compliance or any attempts to comply, with this authorization.

Should my application be accepted, I agree to abide by the Church of the Savior United Methodist church child protection policy and procedures mentioned in the packet and will live by the understanding that, as a person of authority, it is my responsibility to avoid inappropriate behavior with any children or youth in my care.

I further state that I HAVE CAREFULLY READ THE FOREGOING AUTHORIZATION AND RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN IT AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.

Applicant’s signature: _________________________________________Date:______________

Church of the Savior: Boomin’ Event Permission Slip

(Name of child): ______________________ has my permission to go with

the (Name of Group)______________________ on the following event

_______________________________________ at this location

_____________________________________________________________

Signed legal guardian and date:

___________________________________________________________-

IN CASE OF EMERGANCY:

Phone # where parent/guardian can be reached in an emergency:

_______________________________________________

Alternate #: _________________________________________

Please list below any allergies known (drug, physical, insect, foods, asthma

etc)

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Please list any other pertinent health history information:

_____________________________________________________________

_____________________________________________________________

Does your child have any conditions that would prevent him/her from fully

participating in this event? If yes, please

explain:_______________________________________________________

_____________________________________________________________

List any medications needed to be taken during the time of this event (all

medications will be kept with the leaser of the event):

_____________________________________________________________

_____________________________________________________________

Preferred doctor: _________________________ phone #:_______________

Preferred dentist: ________________________ phone #:_______________

Preferred eye doctor: _____________________ phone #:_______________

Preferred Hospital: _____________________________________________

EMERGANCY MEDICAL AUTHORIZATION

I give my consent for emergency medical treatment to be preformed by an individual certified in first aid. In the event that additional treatment is needed, the staff of the Emergency room of the hospital listed above, or the one closest to the event of the location, has my permission to treat my child.

Signature of Parent/ Guardian: ________________________________________

Date: ________________________________________________

(Please Print the following)

Name of Parent/Guardian:_____________________________________

Date:_____________________________

Address:___________________________________________________

Phone #:____________________________________________

(Home and work) :________________________________

Hospitalization plan and group#:___________________________________

Church of the Savior United Methodist Incident Report

This form is to be completed by the adult supervisor whenever an incident occurs (injury, accident). A copy is then to be given to the child’s parent/guardian and the pastor. The church must also keep a copy of the completed form.

Name of class or activity:_______________________________________

Adult Supervisor:____________________________

Name of Injured child:_______________________________

Birth Date:_________________ Current Age: ___________

Name of Parent/ legal Guardian:___________________________________

Address:____________________________ Phone #:___________________

Date and time of incident: ____________________________________

1. Describe the incident on the back of the page

2. Where did it take place? ___________________________

3. What area of the child’s body was injured? ____________________________

4. What was the child doing when the incident occurred?

_________________________________________________________________

___________________________________________________________

5. How did it happen? _______________________________________6. Give the names of the adults supervision the child at the time of the incident:

________________________________________________________________7. Give the names of the witness _____________________________________8. How did the child respond to the incident: ___________________________9. Was the first aid given or some other take action? ___________ Then explain:

_________________________________________________________________

___________________________________________________________________

10. Who notifeied the parent/guardian and when? __________________________

Signature: __________________________ Date_____________________

Church of the Savior United MethodistReport of Suspected Incident of Child/ youth Abuse

Name of person observing or receiving disclosure of abuse: ____________________________________________________________

Victim’s name:__________________________________

Victim’s age and date of birth: ____________________________________

Location and date of initial conversation with or report from victim:

_____________________________________________________________

_____________________________________________________________

Victim’s statement: (please give a detailed summery):

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Notification of pastor (include Pastor’s name, date, time and summary of

report given:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Notification of victim’s parent/guardian (include date, time, name of

parent/guardian contacted, and summery):

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Call to Police Department and Children services (Include date, time, name of

person contacted and summary of report

given):________________________________________________________

_____________________________________________________________

_____________________________________________________________

Signature of person making this report and date:_____________________

__________________________________________________________

Print the name:___________________________

Phone Contact #: _______________________________________________