Date:

 Name:

 Maiden Name:

 Address:

 City/State/Zip:

 Email Address:

 Home Phone:

 Work Phone:

 Cell Phone:

 Cell Phone:

 Date Of Birth:

 Place Of Birth:

How long have you been attending The Sanctuary Of Ocala?
Have you personally accepted Jesus Christ as your Lord and Savior?
Are you committed to having the character of Jesus live through you?

Please list one adult you’ve known for at least one year, who is not related to you and has a definite knowledge of your character and ability to work with children:

 Name:

 Nature of Association:

 Address:

 City/State/Zip:

 Length of Time Known:

 Occupation:

 Home Phone:

 Work Phone:

 Cell Phone:

Marital Status: Please check one Single Married Widowed Divorced

Do you have children of your own?

Yes No

Have you ever been convicted of, or pleaded guilty to, a crime?

Yes No

If you answered "yes" to the above question having to do with crime, please explain below:

The information contained in this application is correct to the best of my knowledge.

I also hereby give authorization for The Sanctuary of Ocala to request information from all public/private records and any other pertinent information relating to the successful function of the ministry for which I am considered.

I hereby release The Sanctuary of Ocala, former emplo-yers, other references, and any of their authorized agents from any liability, and I knowingly understand and agree that there is no invasion of personal privacy.

This authorization, in original or copy form, shall be valid for this and any future reports or updates that may be requested.

Should my application be accepted, I agree to refrain from unscriptural conduct in the performance of my services on behalf of the church.

I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RE-LEASE AS MY OWN FREE ACT.

This is a legally binding agreement, which I have read and understand.

Applicant’s Signature:	Date:
Witness:	Date:
Parent's Signature:	Date:
(Parent's signature required if a student is the applicant)

To provide a safe and secure environment for our child-ren, we ask that you complete the following criminal records release.

IMPORTANT: EVERY APPLICANT, REGARDLESS OF CRIMINAL RECORD, MUST COMPLETE THIS SECTION.

I hereby authorize The Sanctuary of Ocala or any of their authorized agents to receive any criminal history record information pertaining to me which may be in the files of any state or local criminal justice agency.

I hereby release The Sanctuary of Ocala’s former em-ployers, other references, and any of their authorized agents from any liability and I knowingly understand and agree that there is no invasion of personal privacy.

I understand the background investigation will be con-ducted in order to ensure a safe and secure environ-ment for those children who participate in our pro-grams and use our facilities and will be held strictly confidential. This authorization, in original or copy form, shall be valid for this and any future reports or updates that may be requested.

I hereby release local, state, and national law enforce-ment agencies from any and all liability resulting from such disclosure.

Signature:	Date:
Maiden Name (if applicable):	Social Security:

 List All Aliases (if applicable):

The above information will be held confidential by the professional church staff.