MENTOR/VOLUNTEER APPLICATION

This application is to be completed by all volunteers. It is used to help the ministry provide a safe and nurturing environment for its families and children, and to learn more about you as a potential volunteer. Your responses will help us determine your readiness for ministry, at this time, and do not automatically exclude you from being considered.

Before beginning, please set aside ample time to complete the detailed application in it's entirety.  Once you begin, you are unable to stop and return to where you left off.

Please fill out every single blank on
the application and hit the blue SUBMIT button
for proper submission. Once submitted, a "thank you" will pop up confirming form submitted.

Date of Orientation *
Date of Orientation
In what areas are you interested in volunteering? *
What age group are you interested in working with? *
Name *
Name
Date of Birth *
Date of Birth
Your future mentor coordinator will need to communicate with you. What is your preferred method of contact? *
Home Address *
Home Address
Phone number
Phone number
Employment
Work Phone *
Work Phone
Family
Name of Emergency Contact *
Name of Emergency Contact
Phone Number of Emergency Contact *
Phone Number of Emergency Contact
Statement of Faith
Please read the following statement carefully before agreeing: We believe the Bible is God’s infallible Word. We believe the Father, Son and Holy Spirit are co-equal and co-eternal. We believe Jesus Christ is God in the flesh and our only Savior. We believe God created man in His image, but that image is horribly marred by sin. We believe everyone has sinned and is in need of forgiveness. We believe Christ died for our sins and rose again to save us and to free the world from bondage to sin. We believe Salvation is a gift of God by grace alone through faith alone. We believe Christians are responsible to love God, love their neighbors and to make disciples of all nations. We believe Jesus is returning in flesh to judge the world, claim His Kingdom and restore shalom to earth. We believe everyone will spend eternity in heaven or hell.
I agree to the above: *
Marriage, Gender, and Sexuality Policy
As representatives of Jesus Christ, Mercy Street employees, board members, mentors, and volunteers are responsible to demonstrate a lifestyle consistent with His character. They are expected to be men and women of high moral character and men and woman whose sexual conduct is consistent with the standards of Scripture. This includes avoiding any pattern of addiction and abstaining from premarital, extramarital, transgender, and homosexual conduct. Employees, board members, mentors, and volunteers must conform to the above standards. Employees, board members, mentors, and volunteers are also asked to: (1) dress in conformance with one’s biological sex; (2) use the restrooms, locker rooms, and changing facilities conforming with one’s biological sex; and (3) abstain from all intimate sexual conduct outside the marital union of one man and one woman. In addition, I will strive to cultivate these same truths in the heart of my mentee.
I agree to the above: *
We require all potential mentors be an active member of a local church body.
Volunteer Questionnaire
Please take your time and answer the following questions carefully and fully
References
Each applicant must submit the names, emails and phone numbers of at least one volunteer or employment involving children or students reference, one pastoral reference (church pastor, missions pastor, small group leader, mentor) and two personal references (non family). *One of these references should be a person of the opposite sex. All information obtained by your references will remain confidential
Volunteer Supervisor Involving Children or Students Reference
Name *
Name
Address *
Address
Phone *
Phone
PASTOR/ELDER/SMALL GROUP LEADER/MENTOR REFERENCE
Name *
Name
Address *
Address
Phone *
Phone
Personal Reference 1 (Non-Family)
Name *
Name
Address *
Address
Phone *
Phone
Personal Reference 2 (Non-Family)
Name *
Name
Address *
Address
Phone *
Phone
Criminal/Driving Record
Agreement
Please read the following statement carefully before agreeing: I, the undersigned, hereby agree to hold Mercy Street Ministries and all persons or organizations connect with Mercy Street Ministries harmless from liability. I hereby release Mercy Street Ministries to obtain information from my references, and agree to hold harmless from liability any person or organization that provided information concerning me to Mercy Street Ministries. I understand that all information gathered will be kept confidential. I agree that all information in this application is true. I understand that the information collected in this form will be used to conduct a background check, and I authorize representatives of Mercy Street Ministries to conduct state and federal background checks. I agree to strive to honor God through scripture-based teaching and conduct in the performance of any services on behalf of the Ministry and in my life. I understand that throughout my time volunteering with Mercy Street Ministries I will be held accountable through monthly phone or email conversations with Mercy Street Mentor Coordinators and/or other staff. If it is found that I am living my life contrary to scripture I will be removed as a mentor.
I agree to the above: *
MERCY STREET MINISTRIES CHILD ABUSE POLICY
Mercy Street Ministries (hereafter referred to as “Mercy Street”) prohibits and does not tolerate acts or knowledge of child abuse in the workplace or in any organization-related activity. The organization provides procedures for employees, volunteers, or others participating adults to recognize signs of abuse and report suspicions or disclosures. No employee, volunteer, student, or third party, no matter his or her title or position, has the authority to commit or allow abuse. Mercy Street has a Zero-Tolerance policy for any act of abuse committed by any employee, volunteer, board member, or third party including acts of physical, sexual or emotional/mental abuse. Upon completion of investigation conducted by appropriate authorities, disciplinary action up to and including termination of employment or volunteer relationship and criminal prosecution may ensue. Any incidents of abuse reasonably believed to have occurred will be reportable to appropriate law enforcement agencies and regulatory agencies. Definitions of child abuse as well as physical and behavioral evidence or signs include (but are not limited to) the following: Physical Abuse “Physical injury that results in substantial harm to the child, or the genuine threat of substantial harm from physical injury to the child, including an injury that is at variance with the history or explanation given [italics added] and excluding an accident or reasonable discipline by a parent or guardian that does not expose the child to a substantial risk of harm. Physical abuse also includes failure to make a reasonable effort to prevent an action by another person that results in physical injury that results in substantial harm to the child.” Signs and symptoms: • Frequent injuries such as bruises, cuts, black eyes, fractures, lacerations, abrasions or burns that are unexplained and when cause is inadequately explained • Burns or bruises in an unusual pattern that may indicate the use of an instrument • Lack of reaction to pain. • Injuries that appear after the child has not been seen for several days • Injuries involving the backs of the hands, buttocks, abdomen, back, or sides of the body • Frequent complaints of pain without obvious injury • Aggressive, disruptive and destructive or self-destructive behavior • Passive, withdrawn, emotionless behavior • Fear of going home or seeing parents Sexual Abuse “Sexual conduct harmful to a child’s mental, emotional, or physical welfare, including conduct that constitutes the offense of indecency with a child, sexual assault, or aggravated sexual assault; failure to make a reasonable effort to prevent sexual conduct harmful to a child; compelling or encouraging the child to engage in sexual conduct [italics added]; and causing, permitting, encouraging, engaging in, or allowing the photographing, filming or depicting of the child if the person knew or should have known that the resulting photograph, film, or depiction of the child is obscene or pornographic.” Signs and symptoms: • Torn, stained or bloody underclothing • Pain, swelling, itching, bruising or bleeding in genital area • Difficulty walking or sitting • Physical signs of sexually transmitted diseases • Pregnancy in young girls • Inappropriate sex play or premature understanding of sex • Sexually suggestive, inappropriate or promiscuous behavior • Threatened by physical contact/closeness • Extreme fear of being alone with adults especially if of a particular gender • Child suddenly refuses to change for gym or to participate in physical activities • Major change in normal mood or behavior Mental Abuse “Inflicting mental or emotional injury to a child, and/or causing or permitting the child to be in a situation in which the child sustains a mental or emotional injury that results in an observable and material impairment in the child’s growth, development, or psychological functioning.” Signs and symptoms: • Speech Disorders • Delayed physical development • Ulcers, asthma, severe allergies • Substance abuse • Habit disorder (sucking, rocking, biting) • Antisocial, destructive • Sleep disorders • Passive and aggressive-behavioral extremes • Delinquent behavior (especially adolescents) • Developmentally delayed Neglect “The leaving of a child in a situation where the child would be exposed to a substantial risk of physical or mental harm, without arranging for necessary care for the child, and the demonstration of an intent not to return by a parent or guardian of the child.” Signs and symptoms: • Inadequate nutrition that can include stealing or begging for food • Lack of personal cleanliness • Torn and/or dirty clothes • Unattended to medical needs • A child unattended to for long periods of time or consistent lack of supervision • Frequent absence or tardiness from school • Regularly displays fatigue or listlessness or falls asleep in class • Extreme loneliness and need for affection Reporting Procedure As authority above policies set by Champions of Hope, the State of Texas requires all adults to make a report of suspected abuse to Child Protective Services within 48 hours by one of these: • Calling 1-800-252-5400 • Reporting online at http://www.dfps.state.tx.us/Contact_Us/report_abuse.asp • Or to law enforcement by calling 911 or the local police department. Failure to report suspected abuse is a crime. Investigation of the alleged abuse will remain with law enforcement and CPS professionals and should not be undertaken by the individual or organization. If anyone is aware of or suspects that any type of abuse happened or may be taking place, they are to report it immediately to a Mercy Street staff member via phone or email. Guidelines for Mentor and Mentee Interactions Mentors associated with Mercy Street should adhere to the following guidelines regarding one-adult/one-child situations: • When choosing a room or indoor space to use, mentors must use only open areas where they are easily observed and accessed • At no time will mentors be alone with children in isolated areas, including behind closed doors, for any length of time • If using a room with a closed door, the door will either have windows or will be left open • Avoid taking children to the restroom • Never be nude in the presence of children • Whenever possible, travel with another mentor while transporting a mentee; When not possible, go directly to and from an event with a mentee • Physical contact and affection should be appropriate to the child’s age • Inappropriate touching and inappropriate displays of affection are forbidden • Possession of sexually oriented materials is prohibited • No mentor should have a mentored child with him or her overnight, in any context • As always, parental approval will be required for all activities Anti-retaliation The State Law of Texas and Mercy Street prohibit retaliation made against any employee, volunteer, board member, or student who reports a good faith complaint of abuse or who participates in any related investigation. Intentionally reporting false accusations of child abuse is illegal and can have serious consequences for those who are wrongly accused. Mercy Street prohibits making false and/or malicious allegations of child abuse, as well as deliberately providing false information during an investigation. Anyone who violates this rule is subject to disciplinary action, up to and including termination. Investigation and Follow-up Mercy Street will take all allegations of child abuse seriously and will act promptly to ensure the child is safe and appropriate authorities are involved to investigate suspicions or disclosures. Mercy Street will cooperate fully with any investigation conducted by law enforcement or other regulatory agencies. Mercy Street will make every reasonable effort to keep matters involved in allegations of abuse as confidential as possible while still allowing for a prompt and thorough investigation.
I agree to the above: *
MERCY STREET MINISTRIES CHILD SAFETY POLICY
Abuse Tolerance Mercy Street has a zero tolerance for abuse in Mercy Street programs and activities. It is the responsibility of every staff member, mentor and volunteer at Mercy Street to act in the best interest of each child in every Mercy Street program. In the event that any staff member, mentor or volunteer observes any inappropriate behavior (i.e. policy violations, neglectful supervision, poor role-modeling, etc.) or suspected abuse (physical, emotional, or sexual) it is his or her responsibility to immediately report this information to a coordinator, immediate supervisor, or Mercy Street program director. Reporting Suspicious or Inappropriate Behaviors Mercy Street is committed to providing a safe, secure environment for children and their families. To this end, any report of inappropriate behaviors or suspicions of abuse will be taken seriously and will be reported, in accordance with this policy and state law, to the Mercy Street Safety Committee Chair, the Police Department, Child Protective Services, or other appropriate agency. Mercy Street supports and encourages a culture of communication related to abuse or suspected abuse of children. If you see or suspect inappropriate interaction with or between children, it is your responsibility to report the inappropriate interaction to a coordinator, immediate supervisor or program director. This includes partial or inconclusive information concerning behavior, which may or may not be blameless. Because sexual abusers ‘groom’ children for abuse, it is possible a staff member, mentor or volunteer may witness behavior intended to ‘groom’ a child for sexual abuse. Staff member, mentors and volunteers are asked to report ‘grooming’ behavior, any policy violations, or any suspicious behaviors to a coordinator, immediate supervisor or program director. Enforcement of Policies Mercy Street staff members and volunteers who supervise other staff members or volunteers are charged with the diligent enforcement of all Mercy Street policies. Violations of these policies are grounds for immediate dismissal, disciplinary action, or reassignment from positions for staff members, mentors and volunteers. Final decisions related to policy violations will be the responsibility of the Mercy Street Safety Committee and Executive Director. Reporting Violation of Policy In order to maintain a safe environment for our children, Mercy Street staff members, mentors and volunteers must be aware of their individual responsibility to report any questionable circumstance, observation, act, omission, or situation that is a violation of these policies. All questions or concerns related to abuse should be directed to an immediate supervisor, coordinator, or the Executive Director. Consequences of Violation Any person accused of committing a prohibited act or any act considered by Mercy Street leadership to be harmful to a child will be immediately suspended from all interaction with that child and Mercy Street activities. This suspension will continue during any investigation by law enforcement or child protective agencies. Any person found to have committed a prohibited act may be prohibited from future participation as a staff member, mentor or volunteer in all activities and programming that involves children or students at Mercy Street. If such an individual is an employee, such conduct may also result in termination of employment from Mercy Street. Failure to report a prohibited act as designated in this policy is a violation of this policy and grounds for termination of employment of any employee. Mentors or volunteers who fail to report a prohibited act may be restricted from participation in activities involving children or students at Mercy Street. Reporting Suspicions of Abuse to Law Enforcement Agencies Staff members, mentors and volunteers at Mercy Street are required to report suspicions of child abuse or neglect, or any inappropriate behavior of a colleague or co-worker, to their immediate supervisor, coordinator or program director. Texas state law requires that any person having cause to believe a child’s physical or mental health or welfare has been or may be adversely affected by abuse or neglect must make a report to the appropriate law enforcement agency. A staff member, mentor or volunteer may report to an immediate supervisor, coordinator or program director and allow supervisory personnel to make the appropriate report to law enforcement agencies. Staff members, mentors and volunteers are required to report an incident to supervisory staff as soon as possible after the incident. After receiving a report from a staff member, mentor or volunteer, the Program Director will speak with the person to whom the child spoke in order to get detailed information about the conversation. The Executive Director will be notified as soon as reasonably possible. Response to Report of Abuse The Mercy Street Safety Committee will take appropriate action on behalf of Mercy Street when a report of abuse occurs. Any report of inappropriate behaviors or suspicions of abuse will be taken seriously, and will be reported in accordance with this policy to the Executive Director. If appropriate, the Texas Department of Family and Protective Services (1-800-252-5400), or Child Protective Services (817-321-8680) will be notified. Bathroom Supervision and Assistance Guideline Staff members, mentors and volunteers should avoid taking children to the restroom. Elementary students may be accompanied to the restroom for supervision and assistance when needed. (However, the student should receive the minimum amount of assistance needed based upon their individual capabilities.) If a staff member, mentor or faculty must go to the restroom to check up on an individual child they should: 1. Seek out another person to accompany them. 2. If another person is not available to accompany them they should go to the exterior bathroom door, knock, and ask if the child needs assistance. 3. If the child requires assistance, the adult should leave the exterior bathroom door open when entering the bathroom area and try to verbally assist the child in completing their activities while the child remains behind the door of the bathroom stall. 4. Any assistance with the straightening or fastening of garments should only be done in the presence of another staff member, mentor or volunteer. Gift Giving Staff members and mentors are allowed to give two small gifts (under $25) on the child’s birthday and at Christmas. All such gifts will be reported by email (type of gift and cost thereof) to the appropriate Mentor Coordinator or supervisor of the program. Any other special occasions or special accomplishments should receive group acknowledgement and rewarded with group recognition. Any requests for variance from this policy must be addressed in writing to the Program Director or Executive Director. Intoxicants Staff members, mentors and volunteers are prohibited from the use, possession, or being under the influence of alcohol or any illegal drug while in the facility, during a Mercy Street activity, or while working with children at Mercy Street. Staff members, mentors and volunteers and are prohibited from providing alcohol or illegal drugs to children or students. Tobacco Mercy Street is a tobacco-free facility. Mercy Street requires staff members, mentors and faculty to refrain from the use or possession of tobacco products in the facility, and while in the presence of children and students or their parents. Mercy Street staff members, mentors and volunteers are prohibited from providing tobacco products to children or students. Nudity Staff members, mentors and volunteers at Mercy Street should never be nude in the presence of children in their care. One-to-one Interactions with Children and Students Mercy Street recognizes that meeting the spiritual and emotional needs of children may occasionally require that staff members, mentors and children interact with children on an individual basis. Adults should observe the following guidelines when interacting with Mercy Street children: Individual Mettings Staff members, mentors and volunteers should conduct one-to-one meetings with an individual child at a time when others are present and where interactions can be easily observed. There will be no one-to-one meetings between a staff member, mentor or volunteer and a child behind closed doors. If a circumstance arises where a private one-to-one meeting does occur, the staff member, mentor or volunteer will notify the appropriate Program Director immediately before or after the meeting. Transportation 1. Staff members, mentors and volunteers may from time to time be in a position to provide transportation for Mercy Street children. The following guidelines should be observed when adults are involved in the transportation of Mercy Street children: 2. Children should never be transported without parental permission. 3. Children should be transported directly to their destination. No unauthorized stops should be made. 4. Staff members, mentors and volunteers should avoid physical contact with children while in vehicles. 5. No cell phones may be used by the driver in a moving vehicle while providing transportation for children. 6. No drivers under age 21 may provide transportation for children. Children should not use a vehicle belonging to a staff member, mentor or volunteer. Parental Contact Parents of children in Mercy Street programs or activities will be contacted if their child becomes ill, seriously injured, or has a severe disciplinary problem while participating in Mercy Street activities. Parental Involvement Parents are encouraged to be a part of any and all services and programs in which their children are involved at Mercy Street. A parent accompanied by a child to any Mercy Street program or activity is responsible for their child’s safety. Parent Volunteers A parent who desires to participate in such a way as to have ongoing contact with children at Mercy Street, other than his/her own will be considered a Mercy Street volunteer. All volunteers will be required to complete Mercy Street’s Volunteer Application and screening process. Physical Contact Mercy Street is committed to protecting the children in our care. Mercy Street has implemented a physical contact policy that will promote a positive, nurturing environment while protecting our children. Physical contact in any form should not give even the appearance of wrongdoing. The personal behavior of Mercy Street staff members, mentors or volunteers must foster trust at all times – personal conduct must be above reproach. The following guidelines are to be carefully followed by all working in Mercy Street programs: 1. Hugging, pats on the back, high-fives and other forms of appropriate physical affection between staff members, mentors or volunteers and students are important for child development, and are generally suitable in Mercy Street programs. 2. Physical affection should be appropriate to the child’s age. Inappropriate touching and inappropriate displays of affection are forbidden. Any inappropriate touching and inappropriate displays of affection should be immediately reported to an immediate supervisor, coordinator or Executive Director. 3. Physical contact and affection should only be given when in the presence of other children or Mercy Street staff members, mentors, and volunteers. It is much less likely that touches will be inappropriate or misinterpreted as such when more than two individuals are present, and the touch is open to observation. 4. Do not force any physical contact, touch or affection upon a reluctant child. A child’s preference not to be touched must be respected. Release of Children At the end of any Mercy Street planned group activity, Mercy Street staff members, mentors and volunteers are responsible for releasing children in their care only to parents, legal guardians, or other persons designated by parents or legal guardians. In the event that a staff member, mentor or volunteer is uncertain of the propriety of releasing a child, he or she should immediately locate or contact the Executive Director, Mentor Coordinator or Program Director before releasing the child. Sexually Oriented Conversations Staff members, mentors and volunteers are prohibited from engaging in any sexually oriented conversations with Mercy Street children. However, it is expected that from time to time staff members may be called upon to address children regarding human sexuality and purity. Staff members, mentors and volunteers are not permitted to discuss any inappropriate or explicit information about their own personal relationships, dating, or sexual activities with any Mercy Street child. This provision includes using cellular phones, text messages, e-mail, instant messaging, social media and online chat rooms for any such conversations. Possession of Sexually Oriented Materials Mercy Street staff members, mentors and volunteers are prohibited from possessing any sexually oriented materials (magazines, cards, videos, films, etc.) on Mercy Street property or in the presence of Mercy Street children. If any such materials are deemed necessary for purity instruction or discussion, they must be approved in advance by the Executive Director. Internet/Electronic Media No computer at or related to Mercy Street is to be used by staff members, mentors or volunteers to engage in computer chat room discussions or visit pornographic or sexually inappropriate websites. Any questions concerning the appropriate use of computers or the suitability of a particular website should be discussed with the Executive Director, prior to accessing said website. Social Media/Networking A social networking policy exists to safeguard the children, employees, mentors, volunteers and reputation of Mercy Street, and to provide guidelines to assist in utilizing this vehicle of communication. The absence of, or lack of explicit reference to a specific site does not limit the application of this policy. Students Mentors and volunteers are prohibited from ‘friending’ and/or accepting friend requests from current Mercy Street children under age 18. Mentors and volunteers are prohibited from posting anything on a social site of a current Mercy Street child unless the adult is the parent or guardian of that child. Please immediately ‘unfriend’ any Mercy Street child who are your friends on Facebook or any other social network. Mercy Street staff members may use social networking sites to keep up with students. All interactions should be positive uplifting, encouraging and constructive. Staff members are expected to avoid inappropriate language or subject matters in the use of social networking. The Executive Director or his designee may view any private message sent to any student by any staff member at any time, at his discretion. All staff members must ‘friend’ the Mercy Street Executive Director, Associate Executive Director, and Director of Mentoring, if they intend to utilize social media to contact students. Parents Mercy Street expects each employee, mentor and volunteer to maintain an appropriate, positive relationship with parents and caregivers. Should you choose to participate in social networking with parents, please be aware that you are a representative of Mercy Street at all times. Anything you post, including pictures, is a reflection upon Mercy Street. Alumni of Mercy Street Programs It is acceptable to be “friends” through social networks with alumni over the age of 18. Please be aware that uneven power dynamics, in which adults have authority over former program participants, may continue to shape those relationships. Consider that recent alumnae are in some ways similar to current participants due to age, and likely perceive staff members, mentors and volunteers as authority figures. Other ‘Friends’ Remind other members of your network of your position at Mercy Street and that your profile may be accessed by current or former Mercy Street children, and to monitor their posts to your network accordingly. Conversely, be judicious in your postings to all friends’ sites, and act immediately to remove any material that may be inappropriate from your site, whether posted by you or someone else. Privacy Recognize that there is no such thing as complete privacy on a social networking site. Take care in anything you post online. Keep your privacy settings at appropriate levels to protect yourself. Sleeping Arrangements It is anticipated that certain Mercy Street activities may occasionally require that overnight sleeping arrangements be made for children and staff members or volunteers. No mentor should have a mentored child with him or her overnight, in any context. In the event that an approved activity requires sleeping arrangements, staff members and volunteers will strictly observe the following rules; the Executive Director must approve any exceptions to the policies below, in advance: 1. In camp or retreat context, staff members and volunteers will monitor sleeping children periodically conducting visual bed checks to ensure that sleeping children remain in designated sleeping areas. 2. Only children of the same sex will be permitted to sleep in the same room. 3. At times, a staff member or volunteer will sleep in the same room as students or in an adjoining room. However, staff members or faculty are prohibited from sleeping in a 1:1 ratio setting with children for any reason, unless the staff member or volunteer is an immediate family member of the child. 4. In the event that overnight arrangements do not include standard beds, each staff member, volunteer, and child will use single sleeping bags or blankets. In these instances a “one-person-to-one-bag or blanket” rule will be observed. 5. Staff members, volunteers, and students will be required to wear appropriate clothing while sleeping. Supervision Mercy Street staff members, mentors and volunteers are expected to provide adequate supervision for children in their care while involved in Mercy Street programs, including mentoring activities. Some group activities away from Mercy Street facilities may permit youth to function in small, unsupervised groups for brief time periods. When group activities allow for this type of unsupervised functioning, staff members and volunteers should set clear expectations for children concerning times to meet and “check-in” with staff members or workers in charge of the activity. Verbal Interactions Verbal interactions between staff members, mentors and volunteers and children should be positive and uplifting. Adults should strive to keep verbal interaction encouraging and constructive. Staff members, mentors and volunteers are expected to refrain from swearing in the presence of children.
I agree to the above: *