Attendee List "*" indicates required fields Step 1 of 3 33% Name* First Last Email* Student ParticipantsStudent Participants*Please list all student participants coming to Youth Fall Retreat. NameGrade Add Remove ChaperonesChaperone Screening*Please list the name of each adult who will be attending Fall Youth Retreat with your group this year. You will need to conduct a statewide criminal background check (for the state in which the adult resides) for each person listed. Any official state background check that you have conducted within the last three years is acceptable. Please indicate at the appropriate place that the background check has been conducted for each adult. A church staff member must complete this form. Thank you for making the effort to protect the well-being of our students. (www.ProtectMyMinistry.com is a reliable and inexpensive organization to go through for your church’s background checks. ) NameBackground Check Completed (Y/N)Conducted ByConducted On (mm/dd/yy) Add RemoveChaperone Policy*I certify that our church, named below, has conducted a statewide criminal background check for each person listed above, and we affirm them as an adult chaperone for this event. I further certify that I am a staff member of the church named below and, thereby, an official representative of the church. I agree to the chaperone policy.Staff Member Name* First Last Church Name* Church Phone NumberEmailThis field is for validation purposes and should be left unchanged. Δ
