BCC Pastor or Church Leader Family Reference

1

Parent/Caregiver #1 Full Name* This field is required.

First Name

Last Name

2

Parent/Caregiver #2 Full Name

First Name

Last Name

3

Do you have sufficient first-hand knowledge of the family named above to provide a reliable reference for them?

YESNO

4

How long have you known this person in a pastoral capacity?* This field is required.Parent/Caregiver #1

5

How long have you known this person in a pastoral capacity?* This field is required.Parent/Caregiver #2

6

How long has this person attended your church?* This field is required.Parent/Caregiver #1

7

How long has this person attended your church?Parent/Caregiver #2

8

How regularly does this person attend your church* This field is required.Parent/Caregiver #1

Weekly

Monthly

On occasion

Does not attend

9

How regularly does this person attend your churchParent/Caregiver #2

Weekly

Monthly

On occasion

Does not attend

10

Based on their words and actions, does this person in your view demonstrate a personal relationship with our Lord Jesus Christ* This field is required.Parent/Caregiver #1

11

Based on their words and actions, does this person in your view demonstrate a personal relationship with our Lord Jesus ChristParent/Caregiver #2

12

How is this person/couple involved in your church? Are they involved in any particular ministry?* This field is required.

13

Referee's (your) name* This field is required.

First Name

Last Name

14

Your role at Church* This field is required.e.g. Pastor

15

Church name & denomination* This field is required.

16

Phone Number* This field is required.

17

E-mail* This field is required.

example@example.com

18

You verify that this information is true and correct, as of the completion of this form.

Yes