Child & Youth Activity Request Form

Please review the event Policies and Regulations listed below prior to filling out the request form.

Sponsoring Group

Primary Contact Person

Primary Contact Email Address

Name of Activity

Place of Activity

Date of Activity

MM

DD

YYYY

Time Activity Begins

Hour

Minute

Second

Time Activity Ends

Hour

Minute

Second

Have volunteers been screened?

Yes

No

Will you need the church vans?

Have permission forms been distributed and returned?

Yes

No

Additional Information

Agreement

I have read and understand the Child & Youth Advocacy Policy listed below.

The following requirements regarding activities are specified in our Child & Youth Advocacy Policy:

Establishment of A Supervision Process.

(A) The two adult rule: One adult worker and a second adult worker or volunteer will be
present during any church activity where minors are participating.

An adult is defined as anyone 18 years of age or older. However, at least one of the adults
will be over 21 years of age at each church activity.

(B) Adequate personnel: Any church activity where minors are present will be canceled or postponed until the two adult rule can be met Parents or guardians are not to leave minors at activities when two adults are not present. Adults responsible for activities are not to accept
minors for activities until two adults are present.

(C) Activity approval:

1. Church approved activities: All programs and activities involving children and youth must be granted approval by the Church Council.

2. Parental Permission: Church sponsored programs and activities which occur away from the church property will require parental permission for minors to participate.

In order to insure that we comply with these policy requirements, please use the questions below to help in activity planning involving children and youth.