MosaicKIDS Volunteer Form

Full Name - First & Middle, Last

Other Names Known By (include maiden)

Date of Birth

Gender

Male Female

Race

This address will receive a confirmation email

Phone

Address

Please list any other states you resided in.

Please check the appropriate box(es)

Please explain all criminal offenses above.

Please read the following policy:

I understand:

- ALL Mosaic activites shall be tobacco, drug, and alcohol free.
- MosaicKIDS activities are a technology-free zone.
- My actions, as well as clothing, must be appropriate and God-honoring.

By signing this form I acknowledge that I have been provided with a copy of this volunteer form and notice. By signing, I am also consenting to a criminal history background check anytime. I have read and uderstood the foregoing information and certify it is true and correct to the best of my knowledge.

Today's Date

e-Signature (typed is ok for now, we'll have you sign later)

Request to work in these areas:

MosaicKIDS Rooted House Church Childcare Other

MosaicKIDS Volunteer Form

Description

Please Fix the Following