Name *

First Name

Last Name

I agree to do everything in my power to maintain FPCLG as an environment free from any form of abuse. I understand that any violation of this policy will result in disciplinary action, pastoral counsel and possible criminal, legal action. I have read and agree to adhere to the FPCLG Children and Youth Protection Policy (CYPP) and enforce its procedures. If I do not, I will not be able to participate in FPCLG programs or events which involve children, youth or teens. (Section II.) *

I agree.

I agree to participate in a mandatory annual in-person or online CYPP training and fill out the annual Renewal Application form. (Section III. A. and B.) *

I agree.

I agree to help maintain CYPP trained leader-to-participant ratios at all times, in all spaces, combining groups, adding leaders/floaters or canceling programs/events, as needed. I agree to help ensure that there are TWO trained leaders for every FOUR 0-2-year-olds; for every TEN 3-4-year-olds and for every TWENTY 5-18-year-olds. (Section III. C. 2. and 3.) *

I agree.

I agree to have access to completed, signed, submitted permission forms for every child or youth participating in an off-campus FPCLG event. I further agree to follow all FPCLG CYPP policies pertaining to transporting children and youth to or from FPCLG events. (Section III. C. 5. and 8.) *

I agree.

I agree to keep attendance records that include the names of all children, youth and Trained Leaders present, as well as the date and location of the activity, and submit them to the Director of Children's and Youth Ministries. (Section III. C. 9.) *

I agree.

I agree to send only group emails to participants with another Trained Adult Leader copied and not to email an individual child or youth, and to only send text messages to youth if the parent or another Trained Adult Leader is copied (if under the age of 14, it must be a parent that is copied). (Section III. D. 5. and 6.) *

I agree.

If I have any reason to believe that a child or youth's safety has been compromised or that an abuse has occurred or is occurring, I agree to follow through with the following 'P-I-N-C' steps: Protect the child/youth; In the event of injury, call 9-1-1 for appropriate first responders; Notify the person in charge of the activity and/or an FPCLG staff person and Complete an incident report form, found in FPCLG first aid kits. (Section III. E.) *

I agree.

Date *

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