SAFE CHURCH DISCLOSURE FORM

DEANSBORO CONGREGATIONAL UNITED CHURCH OF CHRIST



For a printable copy (PDF) of the safe church disclosure form please click here.

Deansboro Congregational United Church of Christ Safe Church Disclosure Form

 

Name__________________________________

Address________________________________

Phone__________________________________

Name of church where I am a member________________________________

I have been a member of this church since_____________________________

I have been a friend of this church since_______________________________

I have never been found guilty, or pled guilty or no contest, to a criminal charge:

__True __Not True

No civil lawsuit alleging actual or attempted child abuse has ever resulted in a judgment being entered against me, been settled out of court or been dismissed because the statute of limitations has expired:

__True __ Not True

The covenants between persons accepting sanctioned volunteer positions or employment in the church require honesty, integrity, and truthfulness for the health of the church. To that end, I attest that the information set forth here is true and complete. I acknowledge that it is my duty to amend the responses and information I have provided, though accurate when given, when the response or information is no longer accurate.

Signature _____________________________

Date _________________________________

Reviewed by the Moderator _______________________________(signed)

Date _________________________________





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