Refuge 139 Application for FIRST TIME Volunteers
Before you begin, please note that we take Child Safety very seriously. In order to participate in this program, the applicant must not have intentionally viewed pornography for a minimum of 12 months and must pass a Criminal Background Check to qualify. If you have been convicted of child abuse, you will be disqualified from volunteering with JAARS and the Refuge 139 program. If you would like clarification about this before proceeding, please email: keith_franklin@jaars.org.

PLEASE NOTE: In this application you will be asked for passport information, a professional reference, a church reference, emergency contact information, and medical history to include any prescription drugs you currently take. We recommend you gather this information before you start. Once you begin filling out this application, you CANNOT save it to continue at a later time. It must be completed and submitted in its entirety once you begin or your information will be lost. You should allow 20 - 30 minutes to complete this application. Thank you.  
202001US
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Please list your First, Middle, and Last names.
First Name
Middle Name
Last Name
Preferred Name
Date of Birth *
MM
/
DD
/
YYYY
Male or Female
Clear selection
Address Line 1
Address Line 2
City
State
Zip
Country
Email Address
Cell Phone Number
Will you take your cell phone on the trip?
Clear selection
Additional Phone Number
Home, work, etc.
Which number do you prefer to be contacted on?
Check all that apply.
How did you hear about Refuge 139?
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