Leaders and 18 yr+ Certification Form

Adult/Sponsor Certification Form
(Letter of Church Recommendation)

Church Information

Church Name*

Church Phone*

Address*

City*

State*

Zip*

Adult/Volunteer Roster

Name of Adult Volunteer Sponsor (ALL adults attending)	Date of Birth	Sex	Offender Background Check	Criminal History Background Check	Current Training/ Certification	Remove

Attestation by Church Leader

The above named individuals are known to me/us, and I/we can attest to the character, integrity and ability of each to serve as a sponsor. I/we know of no reason why any should not serve as a sponsor for children and youth under the age of 18. I/we also attest to the fact that each of these sponsors has undergone a background check as mandated by the State of Texas and meets the requirements set forth by The Texas Department of State Health Services Rule §265.12 and has successfully completed the required Child Protection Training.

Signature of Authorized Rep.*

Name Printed*

Date*

Signature of Authorized Rep.

Name Printed

Date

Transportation Policy and Agreement

I, , as a representative of Church, agree to the transportation policy stated above for any and all transportation that my group uses on the property of TPCC. I also accept full responsibility for any and all fees, damages or injuries that may occur involving any staff or guests, TPCC property, or other personal property. I have and do hereby hold Trinity Pines, its owners, officers, directors, trustees, agents, employees, and/or volunteers, harmless from any and all claims, liabilities, suits, actions, causes, damages or losses and demands of every kind and nature whatsoever, including without limitation, all costs and attorney’s fees, which may arise from our use of transportation at TPCC.