Risk Form - Immanuel Lutheran Church, School & Preschool

First Name (Full Legal) *

Middle Name (Full Legal) *

Last Name (Full Legal) *

Maiden Name *

Birthdate *

Race *

(Responses listed by the Michigan State i-chat database checklist)

Gender *

Male

Female

Phone Number *

Email Address *

Have you ever been convicted, or plead guilty to, a felony? *

Yes (please explain below)

No

Are you currently on court ordered probation? *

Yes (please explain below)

No

Necessary Explanations

Ministry desired to volunteer in? *

Preschool

K-8 Day School

Children's Ministry (VBS, Sunday Mornings)

Middle School Youth (Confirmation, Youth Events)

High School Youth

Adult Ministries

Construction

If Construction, please list the Trade you are withIf Construction, please list the Trade you are with

Child's Name, Grade and Teacher

(only if you have a student in our school system)

Volunteer Supervisor

(which Immanuel staff are you working with)

Date