The information contained in this application is correct to the best of my knowledge.
I authorise any churches listed in this application to give you any information they may have regarding my character and fitness for youth work.
I release all such references from liability for any damage that may result from furnishing such evaluations to you, and I waive any right that I may have to inspect references provided on my behalf.
Should my application be accepted, I agree to be bound by the PCV’s Safe Church Policy, my signed leader’s Declaration of Commitment, PYV's policies documented in the Camps & Events Manual and PYC Committee decisions, and to refrain from unscriptural conduct in the performance of my services on behalf of PYV.

Please date and sign below if you agree.