Youth Nursery Volunteer – Saint Barnabas

Youth Name*
First Last
Birth Date*
MM slash DD slash YYYY
Current grade level*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email (if you have one)
Phone (if you have one)
Parent Name*
Provide contact information for one parent.
First Last
Parent Email*
Parent Phone*
Why do you want to volunteer in the nursery?*
What kind of experience do you have with helping younger children?*
What qualities do you have that could benefit the children in the Saint Barnabas nursery?*
Reference Name*
Provide a reference who is not a family member.
First Last
Reference Phone
Reference Email*
Agreements*
Check the boxes indicating that you agree with the following:
- I agree to be helpful, respectful, and kind to all children and staff.
- I agree to be an active assistant in the nursery and play with the children.
- I agree to leave all electronics with parents or place them in a cabinet when children are present.
Electronic Signature*
I certify that by typing my name below in the Electronic Signature Field and submitting this form, I intend to sign this document and be bound to the same extent as if I had provided a physical signature.