Please complete one per person *

First Name

Last Name

Male

Female

Married

Single

Date of Birth

MM

DD

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

INFORMATION

Click all that apply.

I have committed my life to Jesus

I am a member of Generations United Church

I have attended a GenU Small Group

I have completed all three steps of Go Points

Has anyone ever brought or threatened to bring a civil or criminal claim against you alleging physical or sexual abuse or sexual harassment? *

Yes

No

Have you ever terminated your employment or had your employment terminated for reasons relating to allegations of physical or sexual abuse or sexual harassment? *

Yes

No

Have you ever been charged, arrested, or convicted of a felony or misdemeanor? *

Yes

No

Have you ever been reprimanded as a student or employee for harassment of another individual or other inappropriate behavior with another individual? *

Yes

No

COMMITMENTS

Please read the following sections detailed in the Go Points Participant Guide and check each statement to express your commitment.

I commit to abide by the Generations United Church Leadership Honor Code.

I have read the Generations United Church Abuse Policy and I agree to report any suspected abuse to the staff person who oversees the area in which I serve.

Date of Electronic Signature

MM

DD

YYYY