1800 Satellite BoulevardDuluth, GA 30097
678-812-4500
contactus@crosspointechurch.com
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Your Name*
Your Email Address*
Applicant's Name*
Today's Date* January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2024 2023
How long have you known this applicant?*
What is your relationship to the applicant?*
Above satisfactory
Satisfactory
Below satisfactory
Can you give an example of how the applicant relates to children?*
Do you know if the applicant has worked with children in the past? If so, what type of work or services with children has the applicant provided? Example: little league coach, mentor, etc.*
Have you ever known the applicant to use harsh or abusive discipline with a child? Do you know of any reason the applicant would pose a danger to any child?*
Would you be comfortable placing one of your own children in the care of the applicant? Why or why not?*
What are the applicant’s hobbies and recreational activities?*
Can you give me an example of how the applicant relates with adults?*
If you can think of a time when the applicant was able to show genuine concern for a person who needed comfort, please tell about that time.*
Do you have any additional comments or questions?
Agree