This form authorizes the church to obtain background information and must be completed by the applicant.  The church must keep this completed form on file for at least two years after requesting a background check.

Children are a gift from the Lord!  Here at Harrisburg Brethren in Christ Church, it is our privilege to minister to, learn from, and love the children of our community.  We know that families today are busy, and it is our goal to make the most of every opportunity to support the members of your family as you respond to God's Spirit.

This application is to be completed by all applicants for any position (volunteer or compensated) involving all church related ministry or supervision of youth and children (under 18 years of age).  It is used to help our church provide the optimum ministry and safest environment for children, youth, and workers alike who participate in our programs and use our facilities.

This section’s information will be strictly confidential.  Only pastoral and the Child & Youth Protection Interview Team will have access to this form.  In order to provide a safe and secure environment for children/youth who participate in our children and youth ministries, we need to ask the following questions.