Kid Country Helper


Welcome to Kid Country! Thank you so much for being willing to serve with the kids. We ask all helpers to fill out this form because we highly value the safety of the children who come to CrossPoint each week. Please fill out all the information and we'll get you plugged into a classroom. Thanks!

Qualifications: a Kid Country helper needs to be a member or a regular attendee of CrossPoint Community Church for at least six months OR have obtained permission to serve from a member of the pastoral staff.

Name

Address

City & Zip

Home Phone

Cell or Work Phone

E-mail

Occupation

Place of employment

Years at CrossPoint

Marital Status

Spouse's Name, if applicable

Name of small group leader, if applicable

Two personal references (over 18 and non-related):
Name & Phone

Name & Phone

Options for serving (select ONE of the two options)

Option One
Serve all Sundays in any three months
January
February
March
April
May
June
July
August
September
October
November
December
Whichever 3 months I'm needed most

Option Two
Serve one Sunday each month (plus one fifth Sunday)
First Sunday of each month, plus Jan 31
Second Sunday of each month, plus May 30
Third Sunday of each month, plus Aug 29
Fourth Sunday of each month, plus Oct 31
Whichever week I'm needed most

Choose the service you'd like to serve:

Choose the age group you'd like to serve with:
Early Childhood (birth-35 mos)
Preschool (3 yrs-kindergarten)
Elementary (Grades 1-2)
Tweenage (Grades 3-5)
Bridges (special needs ministry)
Wherever Needed Most
I'd like to serve in my child's class
Child's Name

How would you like to be contacted regarding your classroom assignment?

(Don't forget to let us know if your addresses change)

Additional Comments?

Helper Statement:
The information above is correct to the best of my knowledge. I authorize any references or organizations to give information regarding my character or fitness for working with children and I release all such references from liability for any damages that may result from furnishing such information to CrossPoint Community Church, Modesto. I have never been convicted of a crime involving the actual or attempted abuse or molestation of a minor.
I agree

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we live life together

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209.521.0181 | 1301 12th Street, Modesto, CA 95354 |info@cpmodesto.org