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Pender United Methodist Church Record of Initial Child Protection Policy Training

Must be completed by Pender United Methodist Children/Youth Paid Staff and Child/Youth Assigned Volunteers:

Please fill out the following; sign, date, detach and return this form to indicate that you have received training on the
Child Protection Policy and Procedures of Pender United Methodist Church.

Name:

______________________________________

Address:

______________________________________
______________________________________
______________________________________

Home Phone:

______________________________________

Position/Area to work with Children/Youth: ________________________________

On the date noted below, I have received training on the PUMC Child Protection Policy and Procedures. I
understand the policy and agree to abide by it.
__________________________________________ ________________________
(Trainee’s Signature)
(Date)
__________________________________________ ________________________ (Instructor’s or PUMC
Representative’s Signature)
(Date)

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