First Name:            Last: 

Your Student(s): 

Address:  

 City:            Zip Code: 

Email: 

Cell: 

Home Phone:     Is it OK to call during the day   Yes   No

What Do You Do?: 

Work Phone:     Is it OK to call during the day   Yes   No

What is the best way to reach you quickly?: 


What are your top 3 concerns about raising youth? 
     1)  

     2)  

     3)  

When do you think is the best time to do youth parent meetings?

What other groups are you involved with at the church?

(Do you want more info about any other?  If so what?) 

Do you own/have connections for any of the following (& it could have potential for youth ministry stuff)?: 
-Please check & say more...

Pool -
Boat -
Lake House -
Farm/Ranch -
Beach Home -
Mountain Getaway -
Community Pool Access -
Other -


Would you be willing to drive students with your own vehicle for youth events?  Yes   No         
          During the week?          During the weekend?          During the week in the summer?          How many besides driver? 

Would you be willing to drive the church van (after training) for youth events?  Yes   No
          During the week?          During the weekend?          During the week in the summer?   

Would you be willing to help transport an individual youth to a youth event?  Yes   No

Would you be willing & able to haul big objects with a truck or trailer?  Yes   No  
          Truck?          Trailer?

Would you be willing to make/bring food upon call for youth events?  Yes   No

Would you be willing to be a prayer partner for a youth?  Yes   No

Would you be willing to help be a mentor for a youth council member?  Yes   No

Would you be willing to attend youth events as a youth volunteer?  Yes   No

Would you be willing to attend youth events as a chaperone?  Yes   No

Would you be willing to teach youth Sunday School?  Yes   No

Would you be willing to lead a small group Bible Study?  Yes   No

Would you be willing to help with various and eclectic administrative tasks?  Yes   No

Would you be willing to make phone calls for youth needs?  Yes   No

Would you be willing to go on a week-long mission trip?  Yes   No

Would you be willing to go on a week-long activity trip?  Yes   No

Would you be willing to be a counselor for summer camp?  Yes   No

What else should the Youth Staff know?...