Confidential

Refresher Application for Workers with Children and Youth

Fourth Baptist Church · Fourth Baptist Christian School

Personal Information

Last Name *

First Name *

Middle Name

Birth Date *

Present Address *

City *

State *

Zip Code *

Home Phone

Work Phone

Cell Phone

Email *

In what area of ministry do you desire to serve? *

In what area of ministry do you currently serve? *

Have you ever been arrested, convicted of, or pleaded guilty to a crime? *

NoYes

Do you have a driver's license? *

YesNo

Social Security Number *

I have read the Child Policy and agree to abide by the policy set forth by Fourth Baptist Church.

Signature *

Typing your full name serves as your electronic signature. Date: 9/3/2026

Records are kept in a secured location by church staff. Your application is not stored on this website.