Safe Church Policy & Disclosure Forms

Safe Church Policy (Sample) and Disclosure Forms to download, print...



The Church Policy for Safety is a 6 page document which includes 2 disclosure forms.

These two forms are:

  • Authorized Volunteer Application and Disclosure Form
  • Employment/Authorized Children and Youth Volunteer Application and Disclosure Form


This policy is for workplace safety and can be used as a model or sample for your church to create their very own policy. It does not cover every issue that you may want to consider in the development of such a policy. Nor does it reflect the law of each and every state. Consistent with the practice of local churches and other settings are encouraged to consider adopting policy as adapted, revised, or changed to meet their own unique circumstances, state laws, or other factors.

It is very important that the policy you adopt and implement complies with applicable federal and state laws regarding employment, privacy, and inquiries regarding criminal history. All laws are subject to change from time to time by action of state legislature, Congress, and state and federal courts. Therefore, you should develop and periodically review your policy with the assistance of persons knowledgeable in these laws. You are encouraged to consult with your own legal counsel and professional advisers before adopting any policy for workplace safety.

The Authorized Volunteer Application and Disclosure Form is attached to the church policy below and includes:

  • Applicant's Name, Address, Phone and Email
  • Applicant's References (3) including their Name, Address, Phone and Email
  • Several Questions Related to Application
  • Applicant's Name, Signature and Date (If under 18, the parent or guardian's signature and date)
  • Date the Sex Offender Registry Review was Performed
  • Date the Personal Interview was Conducted by Staff
  • Date the Reference Inquiries was Completed

The Employment/Authorized Children and Youth Volunteer Application and Disclosure Form is also attached to the church policy below and includes:

  • Applicant's Name, Address, Phone and Email
  • Applicant's References (3) including their Name, Address, Phone and Email
  • Several Questions Related to Application
  • Applicant's Name, Signature and Date (If under 18, the parent or guardian's signature and date)
  • Date the Sex Offender Registry Review was Performed
  • Date the Personal Interview was Conducted by Staff
  • Date the Reference Inquiries was Completed
  • Date the Church Membership for 6 Months or Association for 1 Year Confirmed
  • Date the Safe Church Awareness Training and Policy Orientation was Performed
  • Additionally, if considered for employment, Date the Criminal HIstory Verification together with Fair Credit Reporting Act Notices
Click on the link to download the policies and procedures below:

Safe Church Policy and Disclosure Forms


If you need to modify this form, try the site: Free PDF Services. You can convert this Adobe file into a Word document free of charge and make the necessary changes.

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