Name *

First Name

Last Name

Address *

Where are you currently residing?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Age *

MM

DD

YYYY

Marital Status *

Single

Married

Other

Do you attend Bethesda *

Yes

No

Have you accepted Christ as your personal Lord and Saviour and committed to following Him with your whole heart? *

Yes

No

Are you currently in a small group at Bethesda? *

Yes

No

Role Interested In *

Check one

Team Member

Media/Tech Coordinator

Reference #1 *

First Name

Last Name

Phone for Reference #1 *

(###)

###

####

Reference #2 *

First Name

Last Name

Phone

(###)

###

####

Permission *

Please read the following information carefully before signing this application. I give Bethesda Pentecostal Church the right to investigate all references and to secure additional information about me. I hereby release from liability Bethesda Pentecostal Church and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. I certify that the information provided on this form is correct and complete to the best of my knowledge and I have not withheld any information that would unfavourably affect my application for becoming a small group leader. I understand that information on this form may be verified by Bethesda. I agree to protect the privacy and confidentiality of all personal information I become aware of through serving as a small group leader at Bethesda and agree not to copy, transmit, or share this information except with the consent and direction of Bethesda staff. I commit to not do anything to undermine or work against the mission of Bethesda and to respect the authority of Bethesda church leadership. I will do my best to demonstrate teamwork, dependability, safety, integrity, and kindness in my volunteer service.

Yes

No