Usher Team Application - Saving Grace Church

First Name *

Last Name *

Phone Number *

Email *

Birthday *

Have you been a Pennsylvania resident for the past 10 or more consecutive years? *

Have you at any time ever been arrested for any reason? *

Have you at any time ever been convicted of, or plead guilty or no contest to, any crime (other than a minor traffic violation)? *

Have you at any time ever engaged in, or been accused of, any child molestation, exploitation, or abuse? *

I recognize that Saving Grace Church is relying on the accuracy of the information I provide on this Volunteer Release form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct. *