Author: Janet Duncan

Reducing the Risk II:
Making Your Church Safe
From Child Sexual Abuse
Sample Forms & Policies
Prepared by:
Rev. Dottie Miller, Associate in Children’s Ministries
Spring Arbor Free Methodist Church, Spring Arbor, MI
With input by:
David L. Wills, Attorney-at-law

Adapted with permission from
Reducing the Risk II:
Making Your Church Safe from Child Sexual Abuse
James F. Cobble, Jr, Richard R. Hammar, Steven W. Klipowicz
Copyright © 2003
Although these materials have been reviewed by our attorney in Indianapolis, they may or may not hold up to all the technicalities of your states legal system. Before you officially adopt them for your conference or church, you are strongly encouraged to check with your attorney as to its validity in your state.

Letter to Pastors and Lay Leaders
Child Sexual Abuse Prevention Policies…………………………….1
Paid Employees………………………………………………………..2
Volunteer Workers……………………………………………………..2
Primary Screening Policies and Procedures……………………….3
Secondary Screening Policies and Procedures……………………5
Supervisory Policies and Procedures………………………………..6
Primary Screening Forms (sample)………………………………….8
Secondary Screening (sample)……………………………………..11
Reference Contact Form (sample)…………………………………12
Resources…………………………………………………………..…15
Appendix
Policy Guidelines for
Ensuring the Safety of Children in the Church
Safety procedures in effect at the Spring Arbor Free Methodist Church

Dear Pastors and Lay leaders,
The Free Methodist Church of North America has officially adopted Reducing the Risk II: Making You Church Safe from Child Sexual Abuse by Cobble, Hammar, and Klipowicz as the recommended resource for Free Methodist churches in setting local policy for prevention of sexual abuse.
I have adapted these policies from that resource, with permission of the publisher, Christian Ministry Resources. In it you will also find sample policies on reporting allegations and responding to allegations. I strongly recommend that you obtain this resource. You may order it online at www.reducingtherisk.com or by calling 1.800.222.1840 (8AM-4PM EST).
For $49.99 you receive…
Book: Reducing the Risk II: Making Your Church Safe from Child Sexual Abuse
Video or DVD
Reporting Procedures
Training Manual
Responding to Allegations of Abuse
In the appendix, you will find the policies and procedures we use at Spring Arbor Free Methodist Church.
I remain at your service in the service of the King.
Rev. Dottie Miller
Associate in Children’s Ministries
Spring Arbor Free Methodist Church
Spring Arbor, MI

CHILD SEXUAL ABUSE
PREVENTION POLICIES
Free Methodist Church of North America
Definition
Child Sexual Abuse: General legal description includes any contact or interaction between a child and an adult in which the child is being used for the sexual stimulation of the adult or another person.
Policy Objectives
The purpose of these policies is to assist your church to:
Safeguard the children and youth of your church from sexual molestation.
Protect church staff and volunteer workers from allegations of sexual abuse.
Limit your church’s legal risk and liability due to sexual abuse.
All workers require screening
whether paid or volunteer!
To guard against sexual abuse, every church must implement an effective screening program. The manner in which this is done and the screening forms used should be a matter of careful thought by the church. As an organization, the local church depends upon both paid workers and a large number of congregational volunteers. This presents a challenge to any screening procedure.
Is screening important?
Ask any member of a church in which
an incident of sexual abuse has occurred.

Paid Employees
If your church hires an employee who later molests a child, a key legal issue will be the steps your church took to screen that individual. The screening form your church uses must ask direct questions that help you identify applicants that should not work with youth or children.
Not screening paid employees that work with children puts the church and it’s leaders in serious legal jeopardy. No court will tolerate irresponsible attention to this need. Churches across the nation are recognizing the seriousness of this concern. Therefore, screening is now beginning to receive the attention it deserves.
Volunteer Workers
Most churches also depend upon a large number of volunteer workers. Some of them volunteer many hours each week. Others serve only a few hours a year. Most church volunteers work in some way with youth and children. These volunteers must also be screened. Churches face the same legal vulnerabilities using volunteer workers as they do using paid employees.
Screening paid employees can be direct and straightforward. Screening volunteers may present some obstacles. It is often hard to recruit volunteers in sufficient numbers. They may balk at having to answer questions that seem distrustful of them and invasive of their private lives. Program leaders may be hesitant to enforce measures that could cause people to decline to serve. Nevertheless, if a church is to lower its legal risk and provide a safe place for children, youth and workers; screening must be done.
An effective screening process must take into account the tension that exists between legal demands and practical reality. In light of this dilemma, we will illustrate the use of two screening procedures.

Primary Screening Policies and Procedures
Note: These are to be used with all applicants and church workers, full-time or part-time, compensated or volunteer, including clergy, according to the guidelines below.
The primary screening procedure provides the church with the best potential for reducing legal risk. This procedure consists of the following:
Employment application
Screening form (see attached sample, pp 9-12)
Personal interview
Reference checks (see attached sample, p 13)
Each part of the procedure should be completed before the person begins work at the church. This includes both paid and volunteer workers. If you did not screen current staff members, these procedures should be completed retroactively.
Use a Screening Form
The primary screening form (see attached sample, pp 9-11) should ask for at least the following:
Applicant’s name (identity should be confirmed by photo identification)
Address
Full explanation of any prior criminal convictions for sexual abuse, molestation, or related crimes
Area of work the applicant is interested in
Any training or education in child or youth work
Description of church membership over the past five years
Description of any youth work (at churches or any other organization)
Names and addresses of two personal references and two professional references OR two letters of reference (see attached)

Conduct A Personal Interview
People applying for higher risk positions (such as boys groups, scouting groups, camps, overnight or largely unsupervised activities involving children or youth) should be interviewed by a responsible staff member who has been trained to screen children and youth workers. Law enforcement personnel and local offices of state agencies responsible for investigating reports of child abuse often have materials that can be used to train the staff member who will conduct interviews. So do other youth organizations such as Big Brother/Big Sisters, Boy Scouts, Girl Scouts, Boys Clubs, Girls Clubs, and YMCA/YWCA. Employees of these agencies are usually more than willing to help a church representative learn how to conduct a screening interview.
Keep A Record Of Contacts With References And Prior Churches
This may be done with letters of reference (see p 14).
Completing a screening form is not enough to protect a church and its members. Significant protection only happens if the church takes additional measures.
Contact each reference listed and make a written record (see attached sample) of each contact. Show the date and method of the contact, the person making the contact as well as the person contacted, and a summary of their remarks. The completed forms should be kept with an individual’s original application.
Be sure to contact each church in which the applicant has indicated he has had experience in working with children or youth. Place in application file written record of all of the information contained in the preceding paragraph. These procedures should be done with all children and youth workers. If letters of reference do not come in, follow up with the applicant is necessary to get them on file.
Should religious conversion make a difference
for a worker who has been guilty of
child molestation in the past?
Occasionally, such persons freely admit to a prior incident, but insist that they have since had a conversion experience and that they now present no risk whatsoever. The safest course would be to encourage such an individual to work in the church, but in a position not involving access to children or youth. A church that permits such an individual to work with children or youth, on the basis of the professed religious conversion, will have a virtually indefensible position should another incident of molestation occur. The church’s defense—that the molester claimed to have been converted—would likely be viewed with derision by a civil court. Churches that place a known child molester in a position involving access to children are taking an enormous risk.

Qualified privilege —Many states recognize a “qualified privilege” on the part of employers to share information about former employees with other employers. This ordinarily means that such statements cannot be the basis for defamation unless they are made with “malice.” Malice meaning either that the former employer knew that the statements made were false, or that statements were made with a reckless disregard as to their truth or falsity. In other words, so long as you have a reasonable basis for the statements you make about a former worker, your remarks will be protected in many states by a qualified privilege. A local attorney can advise you whether or not your state recognizes a qualified privilege under such circumstances.
Release form—In many states, you will be able to share your legitimate concerns about a former worker without fear of legal liability if the worker signs an appropriate release form that consents to your evaluation and releases you from any legal liability for any injury or damages caused by remarks you share. Of course, this is legal document that should be prepared by an attorney. (Notice that sample release language is incorporated into the applicant’s statement at the end of the sample screening application.)
Secondary Screening Policies and Procedures
For Occasional Volunteers Only—Emphasis must be given that a secondary screening procedure is for use only with occasional volunteers. These are individuals who only serve a few hours each year. All paid and regular volunteer workers must use the primary screening procedure.
Example: Your Church hires someone to assist weekly with the infants’ nursery on
Sunday morning. As a church employee, the worker must follow a primary screening procedure. A secondary screening procedure should not be used with paid employees.
Example: Same facts as the above example, but the worker is an unpaid church volunteer. As a “regular ongoing worker,” whether paid or not, member or not, the worker must use the primary screening procedure.
Example: Same facts as preceding example, but the worker is an unpaid church volunteer who only helps in the nursery a few times a year.
For Church Members Only—A secondary screening procedure is for church members only. Nonmembers must use the primary screening procedure. This is a key point. To be effective, a secondary screening procedure must be coordinated with the church’s membership application and interview process. At the time of membership, including a transfer of membership, the church should obtain a description of church membership and volunteer work during the past five years and the names and addresses of two references.

Follow The “Six Month” Rule—Volunteers should only be permitted to work with youth or children after they have been regular attenders of the church for six months. Such a policy gives the church an additional opportunity to evaluate applicants and volunteers and will help to repel persons seeking immediate access to children. The only exception to the “Six Month” Rule is a Member Transfer who is in good standing.
Volunteers With Criminal Abuse Violations Not Accepted—Adults who have been convicted of or plead guilty to either child sexual or physical abuse should not work with children or youth in any capacity, volunteer or paid.
Obtain An Agreement To Follow Policies. Finally, the volunteer must complete the secondary screening procedure form, (see attached sample) and sign it, agreeing to follow church policies with respect to working with children or youth. A verbal confirmation should be obtained that the member understands the commitments agreed to under the provisions of the secondary screening procedure. Carefully store all forms in a locked file.
When the church first begins a screening procedure for volunteer workers, those
already active in volunteer service should also be complete the screening process. If
any current volunteer has a criminal conviction or has plead guilty to sexual or child
abuse, that individual must be sensitively relieved of any duties in working with youth or
children.
Supervisory Policies and Procedures
Use a Team Approach—The Two Adult Rule
Consider adopting a “two-adult” rule. Such a rule says that two adult supervisors should be present during any church activity. Preferably one of these adults would be a parent of one of the participating children or youth, or at minimum, someone over 21 years of age. This rule reduces the risk of sexual molestation and also reduces the risk of false accusations of molestation by individuals seeking a quick legal settlement.
Discuss Suspicious Behavior Immediately
Any inappropriate conduct or relationships between an adult worker and a child or youth should be confronted immediately and investigated. Prompt warnings should be issued when appropriate and the situation should be monitored very closely. The adult worker’s services should be terminated immediately for continued violation of such warning or for a single serious violation. Church staff should note when a child or youth appears aloof or withdrawn or exhibits a marked personality change. This may indicate a problem that deserves attention.
Install Windows On Classroom Doors
Consider installing windows on the doors to all classrooms or other areas used by minors. The windows should be made out of shatterproof glass. Doors to classrooms without windows should be left open during use so that persons passing by can observe inside. Also, department leaders or other church leaders should make random visits to all classrooms and frequently visit or inspect areas of church buildings that are isolated from view.
Provide Adequate Personnel
Programs that involve children and youth should always include adequate supervisory personnel. Supervision should also be maintained before and after the event until all children are in the custody of their parents or legal guardians.
Observe An Overnight Rule
All adult chaperones and supervisors should be cleared in advance with the proper church leaders for overnight activities.
Use a Church Nursery Identification Procedure
Procedures should exist for the church nursery that clearly identify the child and the child’s parent or guardian. Children should only be released to a properly identified and preauthorized adult.
Our attorney has reviewed the above policies and approved them as sample policies.

CONFIDENTIAL
(sample)
Primary Screening Form for Children or Youth Workers
for the Free Methodist Church
This application is to be completed by all applicants for any position (volunteer or paid) involving the supervision or custody of minors. This in not an employment application form. Persons seeking a position in the church as a paid employee will be required to complete an employment application in addition to this screening form. It is being used to help the church provide a safe and secure environment for those children and youth who participate in our programs and use our facilities.
Name __________________________________ Date ________________
Identity must be confirmed with a state drivers license or other photographic identification.
 Yes, identity has been verified with a state drivers license or other photographic identification.
Address ________________________________________________________
City _________________________ State _________ Zip _____________
Phone (_______) ________-____________
Please indicate the type of youth or children’s work you prefer:
____________________________________________________________________
Date you are available to begin _______________________________
What is the minimum length of commitment you can make?
_______________________________________________________________________
Have you ever been convicted of or plead guilty to a crime?
 No
 Yes (If yes, please explain. Attach a separate page is necessary)
___________________________________________________________________
___________________________________________________________________

(Sample) Primary Screening Form Continued
5. Do you have a current driver’s license?
 No
 Yes, my driver’s license number is ______________________________
6. Please name the church of which you are a member: __________________________
List the name and address of other churches you have attended regularly during the
past five years.
1. ________________________________________________________________
2. _________________________________________________________________
3. _________________________________________________________________
List all previous church work involving youth or children. List each organization’s name and address, type of work performed, and dates.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
List all previous non-church work involving youth. List each organization’s name and
address, type of work performed, and dates.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
(Sample) Primary Screening Form Continued
List any gifts, callings, training, education, or other factors that have prepared you for children or youth work.
_______________________________________________________________________
_______________________________________________________________________
Personal References (not former employers or relatives)
Name___________________________ Name___________________________
Address __________________________ Address __________________________
City _____________________________ City _____________________________
State ______________ Zip _________ State ______________ Zip _________
Phone (________) ________-_________ Phone (________) ________-________
The information contained in this application is considered to be correct to the best of my knowledge. I authorize any references or churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children or youth work. In consideration of the receipt and evaluation of this application by the Free Methodist Church, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family on account of compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.
Should my application be accepted, I agree to be bound by the bylaws and policies of the Free Methodist Church and to refrain from unscriptural conduct in the performance of my services on behalf of the church.
I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release of my own free will. This is a legally binding agreement which I have read and understand.
Applicant’s signature __________________________________ Date ______________
Witness ____________________________________________ Date ______________

SECONDARY SCREENING FORM
(Sample)
The disturbing and traumatic rise of physical and sexual abuse of children has claimed the attention of our nation and society. The following policies reflect our commitment to provide protective care of all children, youth, and volunteers who participate in church sponsored activities.
Adults who have been convicted of either child sexual or physical abuse must not volunteer service in any church sponsored activity or program for children or youth.
All adult volunteers working with youth or children are required to be regular attenders of
the Free Methodist Church for a minimum of six months. The only exception being a
Member Transfer who is in good standing.
3. Adult volunteers will observe the “two adult” rule. This requires that adults are ever alone
with children or youth without an adult partner.
4. Adult volunteers will immediately report any behaviors which seem abusive or inappropriate
to their supervisor.
Please answer each question—your response will be fully confidential.
As a church volunteer, do you agree to observe all church policies regarding working with youth and children?
 Yes  No
Have you ever been convicted of or plead guilty to a crime?
 No
 Yes (If yes, please explain. Attach a separate page if necessary)
_____________________________________________________________________
_____________________________________________________________________
I have read the above policy and agree to observe the safeguards listed.
Signature _______________________________ Date _____________________
Print Name ______________________________

Reference Contact From
CONFIDENTIAL
(Sample)
Record of Contact With a Reference or Church Identified
by an Applicant for Youth or Children’s Work
Name of Applicant _____________________________________________________
Reference or church contacted. (If it is a church, identify both the church and the person or minister contacted.)
___________________________________________________________________
Date and time of contact _______________________________________________
Person contacting the reference or church ________________________________
Method of contact (For example: telephone, letter, personal conversation)
___________________________________________________________________
Summary of conversation (Summarize the reference’s remarks concerning the applicant’s suitability for youth or children’s work.)
___________________________________________________________________ ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Legible signature __________________________________
Position _________________________________________
Date ____________________________________________

Resources
Children
I Can’t Talk About It (for girls)
By Doris Sanford, Multnomah Publishing
Something Must Be Wrong With Me (for boys)
By Doris Sanford, Multnomah Publishing
Adults
Good ‘N Angry
By Les Carter, Baker Publishing
Released From Shame
By Sandra Wilson, Intervarsity Press
Perfect Every Time
By Rineheart, NavPress
A Door of Hope
By Frank, Here’s Life Publishing
Secrets of Your Family Tree
By Carder, Henslin, Townsend, Cloud, Brawand, Moody Press
Taking Hold of Tomorrow
By Hayford, Regal Books
The Lies We Believe
By Thurman, Nelson Publishing

CHRISTIAN ALL S¶T¶A¶R¶S
REFERENCE FORM
_________________________ is applying to become a volunteer youth worker with the Children’s Ministry at the Free Methodist Church in Spring Arbor, MI, and has given your name as a personal reference. This staff position means being in close contact with children, and we want to ensure that this relationship will be a healthy one. Please complete the form below and use the enclosed envelope to send us your evaluation of this person’s character and integrity. Your response will remain confidential.
1. Describe your relationship with this person:
2. How long have you know this person, and in what capacity?
Please use the following scale to respond to questions 3 through 6:
1 - low 2 - below average 3 - average 4 - very good 5 - excellent
How would you rate his/her ability at the following:
3. Emotional maturity? 1 2 3 4 5
4. Following through with commitments? 1 2 3 4 5
5. Ability to relate to children? 1 2 3 4 5
6. Spiritual maturity? 1 2 3 4 5
What are this applicant’s greatest strengths?
Do you have any concerns regarding this person working with children?
Your Name _________________________________ Today’s Date: _____________________
Address: ______________________________________________ Phone:__________________
City, State, Zip: ________________________________________________________________
Thank you for taking time to complete and return this reference form in the enclosed envelope.
Return Reference Form to: Children’s Pastor
Free Methodist Church
120 Main St., PO Box 399
Spring Arbor, MI 49283
If you have any questions regarding this reference, please call the Children’s Pastor at 517.750.2400, ext 110.

Policies to Reduce the Risk of Harm to Children and Youth
The church shall hold regular training sessions for workers in the area of sexual abuse prevention.
There shall be designated monitors to patrol the building during church functions.
There shall be two adults in classrooms with children. Mature college or high-school students may be used if deemed appropriate by pastoral staff; decided on individual basis.
Department leaders shall monitor activity in their departments.
Children remain the responsibility of their parents during activities where there is no programming specifically designed for them (e.g. potlucks); they should remain in areas of the church where adult supervision is available. The sponsoring group is responsible to provide adequate supervision.
Annually parents will register their children, nursery through fifth grade, for CLC and Sunday School (1 form).
Children, nursery through kindergarten, will not be released from their departments except to parents or other persons designated in writing by parents. Children, first and second grade, will not be released from their department unless written permission is granted by parents. Children in the nurseries will only be released to the parent with the photo ID card.
Bathroom Policy: (1) No child goes without an adult. (2) Open the door and do a quick glance to see if anyone is in the bathroom. (3) Adult waits outside door. (4) If wait seems long, open door, but deal with student from the hallway. (5) If young child needs help, leave the bathroom door open, the stall door open, and stay in view.
Children involved in CFC activities must have signed parental permission form.
There shall be adult escort for the children from the sanctuary to Children’s Church.
All workers with children shall undergo personnel screening procedure, described below.
Personnel Screening Procedures
All workers with children/youth are required to attend the church’s training programs on abuse prevention.
All personnel, both volunteer and paid employees working with children shall fill out the Screening form for Children Workers. The children’s pastor shall be the only person to review forms. A children’s pastor will conduct an interview with workers if there are areas on the completed forms which indicate potential for risk. All forms will be kept secure and confidential.
The Reference Contact and Response form shall be filled out, and sent in by person giving the reference.
All department heads and teachers of children should be members and/or have been attendees for at least six months. Exception may be made for college students who are members in good standing of another church.
Anyone with a history of being an abuser will sensitively be encouraged to find an area of ministry not involving children. THEY ARE NOT PERMITTED TO BE WORKERS WITH CHILDREN IN CHURCH-SPONSORED ACTIVITIES/PROGRAMS.

T or F 1. Child sexual abuse always involves physical contact with children.
T or F 2. Most child molesters are male.
T or F 3. Child molesters are usually strangers.
T or F 4. Victims of sexual abuse suffer no long-term effects.
T or F 5. One out of five molesters begin their activity before age eighteen.
T or F 6. Only a small percentage of victims are male.
T or F 7. Most churches screen workers for potential molesters.
T or F 8. Church leaders cannot be held liable for child sexual abuse.
T or F 9. Some child sexual abuse victims have won settlements of over $1,000,000 from churches.
T or F 10. A child molester who has experienced a religious conversion no longer presents a threat to children.
T or F 11. Child sexual abuse is a criminal offense in all 50 states.
T or F 12. A child molester may have over 500 victims in a lifetime.
T or F 13. Churches have in the past been supportive of victims of child sexual abuse.
T or F 14. Child molesters are seldom known by the victim.

Answers: 1.F 2.T 3.F 4.F 5.T 6.F 7.F 8.F 9.T 10.F 11.T 12.T 13.F 14.F

What is Child Sexual Abuse?
The legal definition of child sexual abuse or molestation varies from state to state, but in general includes any form of sexual contact or exploitation in which a minor is being used for sexual stimulation of the perpetrator.
Child sexual abuse may be violent or non-violent. All child sexual abuse is an exploitation of a child’s vulnerability and powerlessness in which the abuser is fully responsible for the actions.
Child sexual abuse is criminal behavior that involves children in sexual behaviors for which they are not personally, socially, and developmentally ready.
Child sexual abuse includes behaviors that involve touching and non-touching aspects. Types of abuse that involve touching include fondling, oral, genital, and anal penetration, intercourse, and forcible rape. Types of abuse that do not involve touching include verbal comments, pornographic videos, obscene phone calls, exhibitionism, and allowing children to witness sexual activity.
The full extent of child sexual abuse in our country is not known. Current conservative estimates suggest that from 500,000 to over 1,500,000 children are sexually abused each year. The possibility that the number is higher is likely because the greatest percentage of these cases goes unreported. A national retrospective study on the prevalence of child sexual abuse found that 27 percent of adult women and 16 percent of men claimed to have experienced some form of child sexual victimization. Over 25 percent indicated this occurred before the age of nine (Finkelhor, Hotaling, Lewis and Smith, 1990).
Child sexual abuse occurs in all demographic, racial, ethnic, socio-economic, and religious groups. Strangers account for less than 20 percent of the abusers. Estimates indicate that when a known assailant commits the abuse, half of the time it is a father or stepfather, and the rest of the time it is a trusted adult who misuses his or her authority over children.
Symptoms of Molestation
Church workers and staff members should be alert to the physical signs of abuse and molestation, as well as to behavioral and verbal signs that a victim may exhibit. Some of the more common signs are summarized below (Sloan, 1983).
Physical signs may include:
Lacerations and bruises
Nightmares
Irritation, pain, or injury to the genital area
Difficulty with urination
Discomfort when sitting
Torn or bloody underclothing
Venereal disease

Symptoms of Molestation continued
Behavioral signs may include:
anxiety when approaching church or nursery area
refusal to go to school
expresses dislike; doesn’t want to see friends. “ I just want to stay home with you.”
nervous or hostile behavior toward adults
fear of specific persons, situations, strangers
child verbally declares they don’t want to go to a particular person’s house, or shies away when around them or around strangers
sexual self-consciousness
“acting out” of sexual behavior
changes in type of fantasy play
expresses extreme victimization/ violence in play
withdrawal from church activities and friends
isolates self, is sullen: “Leave me alone!”
personality change
outgoing child-leader who becomes withdrawn, change in school performance
poor self-image/low self-esteem
increases negative self-talk: “I’m not good; I can’t do anything right.”
fear of being alone
“Please stay with me. Don’t turn out the light!”
excessive attempt to control environment/fear of unknown
often becomes extremely anxious over unknown aspects of life. “What if our house catches on fire?” or “Mom, I’m afraid.”
Verbal signs may include the following statements:
I don't like [a particular church worker]
[A church worker] does things to me when we are alone
I don't like to be alone with [a church worker]
[A church worker] fooled around with me

The Effects of Child Sexual Abuse
The personal violation of child sexual abuse causes the victim to experience many losses...including loss of childhood memories, loss of health social contact, loss of the opportunity to learn, loss of bodily integrity, loss if identity and self-esteem, loss of trust, loss of sexual maturity, and loss of self-determination. All of these personal violations mean that victims of child sexual abuse lose the child’s right to a normal childhood. In adulthood it may also mean the loss of the capacity to appreciate sexual intimacy as nurturing, holy, and loving. (The Report of the Winter Commission, 1990, Vol. 1, p.118)
Child sexual abuse robs children of their childhood and can potentially scar its young victims for life. Too often in the past, the effects of abuse were minimized or dismissed. Children were viewed as being resilient. Research has shown that children can suffer significant pain from even a single abusive incident. Church members must be aware of the pain and long term suffering that can accompany such abuse. Abuse can result in abnormal fears, post traumatic stress disorder (PTSD), aggressive behavior, sexual acting out, depression, diffused sexual identity, and poor self-esteem (Kendall-Tackett, Williams, and Finkelhor, 1991). The incidence of sexually transmitted disease is also a possible outcome.
The degree of damage depends upon several factors including the intensity, duration, and frequency of the abuse. In addition, the relationship of the perpetrator to the child matters. If the abuser is a known and trusted authority figure in the child’s life, the degree of impact increases dramatically.
An additional burden for the parishioner or client is a sense of being betrayed by God and the Church. This betrayal by one’s pastor represents a major obstacle to the parishioner or client’s personal faith. The damage to one’s spiritual life done by this experience is often profound and long term (Marie Marshall Fortune, Sexual Violence: The Unmentionable Sin, p. 107)
Possible Long-Term Affect of Sexual Abuse
Consequences of child sexual abuse can plague victims into adulthood. When church leaders, pastors, and respected congregational workers perpetrate the abuse, lifelong religious confusion and deep feelings of enmity toward God and the church can occur.

Spring Arbor Free Methodist Church
Screening Form For Children or Youth Workers
This application is to be completed by all applicants for any position (volunteer or compensated) involving the supervision or custody of minors. This is not an employment application form. Persons seeking a position in the church as a paid employee are required to complete an employment application in addition to this screening form. This form is used to help the church provide a safe and secure environment for children and youth who participate in our programs and use our facilities. The information provided will be kept confidential.
Personal
Today’s Date: _________________ ________________ ______________________
mo/day/yr date of birth Social Security #
Name:_____________________________________________________________________________________
Last First Middle
Present Address:____________________________________________________________________________
City, State, Zip: ____________________________________________________________________________
Home Phone: ( ) __________________________________
Personal History
Please indicate the type of youth or children’s work you prefer: _______________________________________
Do you have a current driver’s license? ___ Yes ___ No
If yes, please list your license number: _______________________________________________
Have you attended the church training session on sexual abuse prevention? ___ Yes ___ No
Note: We appreciate the sensitivity of the following questions and your answers to them will be held in strict confidence. You may answer them here or, if you prefer, you may discuss them in confidence with a pastor or counselor. An affirmative answer to any of these questions will not, in itself, disqualify you from ministering to our children or youth. Further, please know that we are fully committed to providing gracious and loving care and nurture for you and for the entire Spring Arbor Family.
Have you ever been convicted of or pleaded guilty to a crime? ___ Yes ___ No
To your knowledge, have you ever had a positive test for HIV, AIDS, or Hepatitis B? ___ Yes ___No
Church History and Prior Work with Children or Youth
List one previous church work involving children and youth (list church, type of work, dates).
Church: ________________________________________________
Type of work:____________________________________________
Dates: __________________________________________________

Personal Testimony
Please write a brief testimony on how Christ came to be Lord of your life, and your relationship with Him now.
Please write your Personal Testimony here:
The information contained in this application is correct to the best of my knowledge. I authorize any references or churches listed in this application to give any information that they may have regarding my character and fitness to work with children or youth. I will hold anyone harmless who in good faith provides you with information about me. I understand that the decision whether or not to allow me to serve in the capacity that I have applied for is completely within the discretion of the SAFMC pastoral staff.
Should my application be accepted, I agree to be bound by the policies of the Spring Arbor Free Methodist Church, and to refrain from any unscriptural conduct in the performance of my services on behalf of the church.
Signed: _________________________________________
Date: ___________________________________________

Name & Address of church of which you are a member
Church: _______________________________________
Address: ______________________________________
City, State, Zip: _________________________________
Person to Contact: ______________________________

List one church you have attended regularly during the past five years (attach additional sheet if needed).
Church: ___________________________________
Address: __________________________________
City, State, Zip: _____________________________
Person to Contact: __________________________

Spring Arbor Free Methodist Church
Children’s Registration Form
Because the safety of children in the church is paramount, children who are regular attendees of the Nursery, Sunday School or Christian Life Club programs of the Spring Arbor Free Methodist Church must be registered for such by their parent or legal guardian.
One form must be filled out annually for each child nursery through fifth grade.
Child’s Name: ________________________________ ____________ ______________ ______
Last First Middle Date of Birth School Grade
Street Address: _____________________________________________________________________
City, State, Zip: _____________________________________________________________________
Telephone: _________________________________________________________________________
E-mail address ______________________________________________________________________
Parent/Guardian Name(s): _____________________________________________________________
Street Address (if different from above): __________________________________________________
City, State, Zip: ______________________________________________________________________
Telephone: _________________________________________________________________________
Emergency Contact: _________________________________________ ________________
Name Relationship Phone
_________________________________________ _________________
Name Relationship Phone
MEDICAL RELEASE FORM
In the event we cannot be reached during an Emergency, I (we) the undersigned give permission for our child to be treated by a licensed physician, and for said physician to administer whatever care is necessary, including anesthesia, for their safety and care.
______________________________________________________ _______________
Signature of Parent or Guardian Date
Please note below any medical allergies, problems, medications being taken or other information that is pertinent.
Are there any concerns or special circumstances of which we should be aware in order to best meet the needs of your child?

Please complete reverse side.

In order that we might locate you as quickly as possible should the need arise, please answer the following questions:
Where would we find you during the Sunday School hour?
Where do you usually sit in the sanctuary?
Where would we find you on Wednesday evenings?

For parents of children from birth through fifth grade:
I give permission for photos of my child to be used in church publications.
____________________________________________________ ____________________
Signature of Parent or Guardian Date

FIELD TRIP PERMISSION
For parents of children age four through fifth grade:
Occasionally teachers arrange field trips as an enhancement to the curriculum. Every effort will be made to make sure that parents are informed of the specifics of such outings as they occur. Signed permission will be assumed effective for the school year. Children without signed permission slips will not be permitted to leave the church building.
My son/daughter _________________________________ has my permission to attend field trips as part of Spring Arbor Free Methodist Church related activities.
____________________________________________________ ___________________
Signature of Parent or Guardian Date

For Parents of children first through fifth grade:
My son/daughter _____________________________________ has my permission to leave the classroom after Sunday School or CLC (children should be instructed where in the church they should meet you). Children will remain in their classrooms until picked up unless this permission is signed.
_________________________________________________________ __________________
Signature of Parent or Guardian Date

For Parents of children younger than first grade:
My son/daughter ____________________________________ may be released to the following persons:
______________________________________ ____________________________________
Name Relationship Name Relationship
_____________________________________________________ __________________
Signature of Parent or Guardian Date

CHRISTIAN ALL S¶T¶A¶R¶S
REFERENCE FORM
_________________________ is applying to become a volunteer youth worker with the Children’s Ministry at the Free Methodist Church in Spring Arbor, MI, and has given your name as a personal reference. This staff position means being in close contact with children, and we want to ensure that this relationship will be a healthy one. Please complete the form below and use the enclosed envelope to send us your evaluation of this person’s character and integrity. Your response will remain confidential.
1. Describe your relationship with this person:
2. How long have you know this person, and in what capacity?
Please use the following scale to respond to questions 3 through 6:
1 - low 2 - below average 3 - average 4 - very good 5 - excellent
How would you rate his/her ability at the following:
3. Emotional maturity? 1 2 3 4 5
4. Following through with commitments? 1 2 3 4 5
5. Ability to relate to children? 1 2 3 4 5
6. Spiritual maturity? 1 2 3 4 5
What are this applicant’s greatest strengths?
Do you have any concerns regarding this person working with children?
Your Name _________________________________ Today’s Date: _____________________
Address: ______________________________________________ Phone:__________________
City, State, Zip: ________________________________________________________________
Thank you for taking time to complete and return this reference form in the enclosed envelope.
Return Reference Form to: Children’s Pastor
Free Methodist Church
120 Main St., PO Box 399
Spring Arbor, MI 49283
If you have any questions regarding this reference, please call the Children’s Pastor at 517.750.2400, ext 110.

Copyright © 2004
Free Methodist Church of North America

1. Lack of trust
2. Confusion of family roles
3. Depression, self-pity, suicide
4. Anger, unresolved and repressed
5. Emotional blocking, turning off
sexually, hypersexuality
6. Denial of experience
7. Isolation—social, shyness, alone,
self-protective
8. Dissociation, psychotic “blacking
out”
9. Sexualization of relationships
10. Anxiety, fears, phobias
11. Sexual dysfunction
12. Eating disorders
13. Substance abuse
14. Promiscuity
15. Disassociation from emotions
16. Possible perpetration of sexual
abuse on others
17. In USA TODAY on January 2, 2002 and article on brain research stated, “According to the Institute of Psychiatry at Medical University of South
Carolina, repeated sexual abuse
causes physical changes in the brain.
This may explain why abused children
often use illegal drugs. According to Carl Anderson of McLean Hospital, damage to this area of the brain may
cause an individual to be particularly
irritable and use outside means to calm
self.”

CHRISTIAN ALL S¶T¶A¶R¶S
REFERENCE FORM
_________________________ is applying to become a volunteer youth worker with the Children’s Ministry at the Free Methodist Church in Spring Arbor, MI, and has given your name as a personal reference. This staff position means being in close contact with children, and we want to ensure that this relationship will be a healthy one. Please complete the form below and use the enclosed envelope to send us your evaluation of this person’s character and integrity. Your response will remain confidential.
1. Describe your relationship with this person:
2. How long have you know this person, and in what capacity?
Please use the following scale to respond to questions 3 through 6:
1 - low 2 - below average 3 - average 4 - very good 5 - excellent
How would you rate his/her ability at the following:
3. Emotional maturity? 1 2 3 4 5
4. Following through with commitments? 1 2 3 4 5
5. Ability to relate to children? 1 2 3 4 5
6. Spiritual maturity? 1 2 3 4 5
What are this applicant’s greatest strengths?
Do you have any concerns regarding this person working with children?
Your Name _________________________________ Today’s Date: _____________________
Address: ______________________________________________ Phone:__________________
City, State, Zip: ________________________________________________________________
Thank you for taking time to complete and return this reference form in the enclosed envelope.
Return Reference Form to: Children’s Pastor
Free Methodist Church
120 Main St., PO Box 399
Spring Arbor, MI 49283
If you have any questions regarding this reference, please call the Children’s Pastor at 517.750.2400, ext 110.

Child Molestation Supplement

This section contains additional illustrational materials for instructional use.
“Sexual abuse occurs when dependent, developmentally immature children and adolescents become involved in sexual activity which they do not understand fully and to which they cannot freely give informed consent.” (Sean Sammon, Slayer of the Soul, p. 6)
In 2001, approximately 903,000 children were found to be victims of child maltreatment. Maltreatment categories typically include neglect, medical neglect, physical abuse, sexual abuse, and psychological maltreatment. More than half of child victims (57 percent) suffered neglect; 2 percent suffered medical neglect; 19 percent were physically abused; 10 percent were sexually abused; and 7 percent were psychologically maltreated. (National Clearinghouse on Child Abuse and Neglect)
In one study done in 1989, 453 pedophiles were found to have committed in their lifetimes 106,916 acts of child molestation against 67,112 different victims. That is an average of 236 victims per molester!
One in three sexual assault victims is under the age of 12. Forty-three percent of those are 6 and younger, 34 percent are 7 to 11. (National Center for Victims of Crime)
A 1996 National Institute of Justice study estimated that each year child sexual abuse in America costs the nation $23 billion. Ninety to 95 percent of all sexual abuse cases are never reported to the police.
A history of childhood sexual abuse leads to a lower health-related quality of life and a greater number of health problems, psychiatric symptoms and diagnoses. Research shows that survivors of childhood sexual abuse have “more medical problems, higher medical use, more physical symptoms, lower health status, and more medical procedures. (American Psychological Association: Understanding Child Sexual Abuse: Education, Prevention, and Recovery.)
“Single mothers are particularly vulnerable to the designs of the pedophile. This person will offer to be a friend to the child participating in sports, taking on hiking trips, etc. The mother, anxious for the children to have a male image, often readily goes along with these offers from ‘such a nice person.’ The fixated pedophile is ‘very good’ to the child as one might expect in pursuing a sexual experience. Pedophiles will go so far as to date or marry a single mother to gain access to her children.” (Delaplane, D. and A. Delaplane. Victims of Child Abuse, Domestic Violence, Elder Abuse, Rape, Robbery, Assault, and Violent Death; A Manual for Clergy and Congregations. Special Edition for Military Chaplains.
Hurting a child is a violation of trust. Unfortunately, it happens every day. And when the abuse is sexual, it can leave a lasting psychological wound that is difficult to heal. JAMA
Children with disabilities are 4 to 10 times more vulnerable to sexual abuse than their non-disabled peers (National Resource Center on Child Sexual Abuse, 1992)
Approximately 2 out of 3 molesters who are caught will sexually abuse again in the future.
As much as 56 percent of reported child molestation cases are committed by adolescents, mostly male. (Roger Katz, “Psychosocial Adjustment in Adolescent Child Molesters” in Child Abuse and Neglect.
Between 1986 and 1996 the estimated number of sexually abused children increased 83 percent. (National Center on Child Abuse and Neglect)
It is estimated that there are 60 million survivors of childhood sexual abuse in America today
Approximately 60 percent of the male survivors samples report at least one of their perpetrators to be female (Mendel, 1993).
The typical child sex offender molests an average of 117 children. (National Institute of Mental Health, 1988).
“Most sexual offenders are male. One in four offenders is a member of the child’s family or a person who has been entrusted with the care of the child. Approximately half are friends of the child or family.” (Child Sexual Abuse: Guidelines for Community Workers, p. 23)
Child molesters can be classified as either preferential or situational. Preferential molesters have a preference for sexual activity with children and will seek them out. Situational molesters do not, but take advantage of a situation to sexually abuse children if it occurs. Sexual abuse may range from a once-in-a-lifetime act to a long-term pattern of behavior. Most offenders are situational and that number is increasing faster than those of preferential child molesters. (Breach of Trust, D-2)
More than 2 million cases of child abuse and neglect are reported each year in the United States. An estimated 150,000 to 200,000 new cases of sexual abuse occur each year. (American Medical Association. JAMA Patient Page: Protecting Our Children—Sexual Abuse of Children Is Common, and Too Often Undetected)

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