Good Shepherd Lutheran Church

Updated May 9, 2012 Good Shepherd Lutheran Church CHILD PROTECTION POLICY Approved by the Congregational Council of Good Shepherd Lutheran Church on April 9, 2012.

TABLE OF CONTENTS Chapter 1. Purpose Chapter 2. Definitions Chapter 3. Application, Screening and Training Procedures Chapter 4. Supervision and Standard Practices Chapter 5. Reporting Abuse Chapter 6. Signs of Child Sexual Abuse Appendix A. Letter from Pastor Appendix B. Application to Work with Children Appendix C. Reference Check Form Appendix D. Child Protection Policy Acceptance Statement Appendix E. Report of Suspected Abuse Form Appendix F. Confidential Notice of Concern Appendix G. Additional Locations to Seek Information Appendix H. Event/Trip Adult Expectations and Information Letter

Chapter 1. Purpose Children are our sacred trust from a loving God. Good Shepherd Lutheran Church joyfully answers the call to provide a nurturing and dynamic Christian environment that will foster our children’s faith, their guiding light. We seek to ensure the safety of all children participating in the programs and activities of the church by establishing the following policies and procedures with regard to the conduct of adults and children. This policy directs that supervision of activities involving children and adults be conducted in a manner that minimizes the risk of abuse or of false allegations of abuse. We seek to protect the children who participate in the activities sponsored by Good Shepherd from abuse and to protect Good Shepherd’s employees and volunteers from false allegations of abuse. Good Shepherd can, through adherence to this policy, make every effort to ensure that persons placed in positions of responsibility and trust with respect to the children of the church, are persons deserving of that trust and responsibility. This policy shall be available in the church office to all visitors, members, and staff of the church. New members shall be made aware of this policy.

CODE OF CONDUCT Those who accept the special responsibility of working with children at Good Shepherd agree to:  treat children with respect and dignity;  do their best to prevent abuse, neglect, and exploitation from occurring to children participating in activities;  not engage in or condone acts of physical, emotional, or sexual abuse;  comply with Good Shepherd Lutheran Church’s Child Protection Policy; and  report any inappropriate behaviors or possible policy violations.

All members, visitors, and guests at Good Shepherd are expected to follow this policy. The Education Ministry and Youth Ministry representatives on council, working with the Pastor and the Coordinator

Good Shepherd Lutheran Church  100 W. Luray Avenue  Alexandria, VA 22301  Child Protection Policy 1 Updated May 9, 2012 of Education Ministry, shall assume responsibility for overseeing the Child Protection Policy. Such responsibility includes supervision and implementation of the policy as well as education and training. The intention of the Child Protection Policy is to protect. The Policy is not intended to substantially interfere with the nurturing, teaching, and supervising of children.

Chapter 2. Definitions Child. For the purposes of this policy, a child is any individual under the age of 18.

Adult. An adult is any person age 18 or older.

Staff. Staff is anyone who works for the Church for salary or wages

Volunteer. A volunteer is anyone who provides services for the Church and receives no compensation in the form of salary, wages, or other pecuniary benefits.

Child Abuse. Child abuse is injury of a child by an adult or older child that is not accidental. It may include physical abuse, emotional abuse, or sexual abuse.

Child Physical Abuse. Child physical abuse is the non-accidental bodily injury of a child through physical contact or mistreatment.

Child Sexual Abuse. Child sexual abuse means any form of sexual contact or exploitation in which a minor is being used for the sexual stimulation of the perpetrator, in other words, “any sexual activity with a child” (National Resource Center on Child Sexual Abuse, 1992). Child sexual abuse is criminal behavior that involves children in sexual behaviors for which they are not personally, socially, and developmentally ready. It includes behaviors that involve touching and non-touching aspects. Sexual abuse perpetrated by an adult is any contact or activity of a sexual nature that occurs between a child and an adult. This includes any activity which is meant to arouse or gratify the sexual desires of the adult or child. Sexual behavior between a child and an adult is always considered to be forced whether or not the child consents to it. Sexual abuse perpetrated by a child is any contact or activity of a sexual nature that occurs between children when there is no consent, when consent is not possible, or when one child has power over the other child. This includes any activity which is meant to arouse or gratify the sexual desires of any of the children. Types of child sexual abuse that involve touching include: · Fondling, · Oral, genital, and anal penetration, · Intercourse, · Forcible rape. Types of child sexual abuse that do not involve touching include: · Verbal comments, · Pornographic videos and photography, · Obscene phone calls, · Exhibitionism, · Allowing children to witness sexual activity.

Good Shepherd Lutheran Church  100 W. Luray Avenue  Alexandria, VA 22301  Child Protection Policy 2 Updated May 9, 2012

Child Emotional Abuse. Child emotional abuse is any language directed toward a child by an adult that is intended to cause emotional anxiety, pain, or other severe emotional disturbance. It is mental or emotional injury to a child that results in an observable and material impairment in the child’s growth, development, or psychological functioning.

Neglect. Neglect is the failure to provide for a child's basic needs or the failure to protect a child from harm.

Economic Exploitation. Economic exploitation is the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a child's belongings or money.

Chapter 3. Application, Screening and Training Procedures

Application Process All adults desiring to work with children at Good Shepherd must apply and be approved. Adults must sign the Child Protection Policy Acceptance Statement and complete an Application to Work with Children. The application requests information about the applicant’s suitability to work with children and may request references and authorization for Church staff to obtain from law enforcement authorities any information they may have regarding the applicant.

Screening and Background Checks A. Applications are reviewed for any areas of concern and an interview with the pastor may be required. Applications and related papers are confidential and maintained in locked files with access limited to the Pastor and the Coordinator of Education Ministry. Good Shepherd will use its discretion in reviewing and investigating the history of each applicant and in determining the activities for which a criminal background check is required. In general, any adults, both staff and volunteer, who will have significant contact with children, be with children off the church property, chaperone overnight events, and/or serve as youth group leaders will be asked to submit to a criminal background check.

B. Criminal background checks will be performed at least every 2 years. In alignment with current information received from the Metro DC Synod office, Good Shepherd will request the following information when conducting a background check through a company that provides such services:  Social Security identification  County courthouse check  Nationwide criminal check  Driving record (if person will be driving youth) Currently, the Metro DC Synod uses Lexus Nexus for conducting background checks. A background check usually costs about $40, more if the person has lived in multiple places. The cost of the background check will be covered through the budget.

(added 5/31/2012 from Suffer the children by Victor Vieth) Although a background check is important, it will only reveal those who have been convicted of a crime against a child.23 This is problematic because most sex offenders, even some who have abused hundreds of children, have never been charged much less convicted of a crime.24 Accordingly, an oral screening of faith workers and volunteers should also be conducted. This screening may include: • Asking the candidate if he has reviewed the church child protection policy and what his thoughts are about the policy. Candidates who don’t believe such policies are necessary or express any hesitancy in abiding by the policies may not be child abusers, but they are also less likely to be vigilant in keeping children safe.

Asking a candidate interested in working with children the basis for that interest. In recommending this question, some experts suggest it may help locate workers and volunteers who understand their role is to help children and not the other way around.25 Offenders are often ego-centric and seek children who meet their needs (i.e., “Children are non-judgmental and make me feel good about myself.”) as opposed to what they can do for children (i.e., “I think I’m a very good teacher and I can help children read and otherwise grow intellectually.”) • Asking a candidate whether they have any adult friendships. Some sex offender treatment providers have noted it is risky to place children in the care of an adult who appears to have no adult friendships or activities—and yet is frequenting settings and putting himself in situations where he has regular access to children. According to sex offender treatment provider Dr. Anna Salter, church groups should “be careful with men who involve themselves in youth activities and who do not have children of their own or children of that age. From church youth leaders to coaches to anyone who befriends your child, notice if they have grown-up friends and partners. If they do not, be very cautious about leaving them alone with your child.”26

• Give the candidate a hypothetical case of potential child abuse and ask how she would handle the situation.27 If the candidate expresses any reservation in following the church child protection policy in response to a hypothetical case, it is a fair assumption that he or she will also hesitate when confronted with an actual case. An oral screening is not a panacea and, similar to a background check, will not catch most sex offenders. This is because many sex offenders understand the “right” answer to many questions and are more than happy to say whatever it takes to get near children. Nonetheless, an oral screening will assist in at least three ways. First, it sends the message that the church is serious about its child protection policies.28 This may deflect some sex offenders to the extent they realize that a church serious about child protection will be more difficult to operate in than a church which only gives lip service to the protection of children. Second, it may take away an offender’s excuses when a church seeks to discipline or remove him for violating policies. For example, if the screener makes it clear that making sexual jokes around children is prohibited, the offender can no longer say “I didn’t realize that” when confronted for violating the rule. Third, an oral screening may help screen out those applicants who may not be child abusers but who will not be vigilant in enforcing the child protection policies.

C. The Pastor will contact applicants regarding any concerns raised by the application, reference checks, or criminal background checks. The Pastor, in consultation with the Coordinator of Education Ministry, shall determine whether the applicant may or may not work with children at Good Shepherd. Good Shepherd will err on the side of caution in restricting an individual from working with children if the background check or other information arouses suspicion or uncertainty about the individual’s ability to safely work with children. Applicants deemed by Good Shepherd to pose a threat to children will not be permitted to participate in Good Shepherd’s activities for children.

Six-Month Waiting Rule An application shall not be approved unless the applicant has been actively involved in Church activities for at least 6 months. The pastor can waive this requirement if it can be verified that, within the last 5 years, the applicant was approved as an adult to work with children in another congregation for at least 1 year, and is in good standing with that congregation. Any waiver and the reasons for granting it will be documented on the applicant’s Application to Work with Children.

Training A. All adults seeking to work with children must be trained on the requirements of Good Shepherd’s Child Protection Policy before being permitted to work with children. Training will be conducted annually, at a minimum, and attendance at the training session will be documented to ensure compliance. Adults working with children will be asked to re-take the training once every 3 years. B. Communication about and an explanation of the Child Protection Policy will be included annually in all training and orientation for programs at Good Shepherd involving contact with children. The responsibility for ensuring the Child Protection Policy is included as part of training programs shall rest with the Coordinator of Education Ministry. Parents and other adults in the congregation are welcome to attend any information sessions or meetings on the Child Protection Policy.

(added 5/31/2012 from Suffer the Children by Victor Vieth) Teach personal safety to children in faith-based schools A personal safety program for children sends a powerful message that the faith community is aware of the need for personal safety and is willing to help if a child is harmed.29 A personal safety program is not the same as sex education. The teacher or other instructor is simply telling children that the parts of their body covered by bathing suits are not supposed to be touched by others and, when they are, they should tell someone. If the person they tell doesn’t believe them, they should keep on telling until they are believed. There are a number of personal safety programs that can be easily modified for a faith-based school.30 In addition to teaching the children personal safety, it is important to provide instruction to the parents so that they can reinforce these lessons at home and will know how to respond if a child makes a disclosure. Some professionals are opposed to personal safety classes because they believe the classes put the burden on the children to protect themselves.31 However, these children have already been led by their perpetrators to believe there is nothing they can do to stop the abuse. A personal safety program may give them a way out. In one case, a three-year-old victim, who had received personal safety instructions from her church day care, subsequently reported to her mother being molested by a twelve-year-old boy. The boy confessed to the offense and was prosecuted in juvenile court.32 This is not an isolated anecdote.

Chapter 4. Supervision Two-Adult Rule A. Two trained adults will be present at all of Good Shepherd's activities and classes involving children. A person new to the church, participating less than 6 months in activities of the church, must work with a trained adult for any activities with children. During Sunday School, when children are attending classes in the spaces separated by dividers in the fellowship hall, it is permissible to have one adult present in each divided space, as long as there are at least two trained adults present in the fellowship hall. B. If absolutely necessary, a teacher or nursery caregiver may work alone if there is visual access to the room (open door or room with a window in the door). C. Exceptions may be made to this two-adult rule when two teenagers are watching children in the church building during adult classes, potluck dinners, etc., that are taking place on the same level of the church building as the location where the children are being watched; and when a teenager is paired with an adult for supervision of preschool children on Sunday mornings. If the activity is not taking place on the same floor as the location where the children are being watched, then at least one trained adult must be present with the teenager to supervise the children.

Personal Conduct A. Common expressions of affection (e.g., hugs), affirmation (e.g., pats on the back, high fives), blessings (e.g., making the sign of the cross on the forehead, laying on of hands), support or physical caretaking (e.g., diaper changing, helping small children in the restroom) are appropriate in this community of caring Christians. Expressions of affection shall not be excessive or imposed upon others. No child should be made to feel guilty if they do not wish to participate in these expressions of affection. Children will be made aware that they are free to participate or not, as they feel comfortable. B. Employees and volunteers shall not touch or interact with children in any way that is intended to be sexually stimulating. Any activity of this type is illegal, as well as a violation of trust and completely inappropriate. C. Corporal punishment or verbal abuse is never permitted.

Open Classrooms Church staff, parents, and church members may visit classrooms and child care rooms at any time without prior notice. The Coordinator of Education Ministry and the Sunday School Superintendent Good Shepherd Lutheran Church  100 W. Luray Avenue  Alexandria, VA 22301  Child Protection Policy 5 Updated May 9, 2012 will make periodic observation of childcare rooms and classrooms during the times when children’s programs are being conducted.

Classroom Discipline All adults participating in programs involving contact with children will be guided by the following constructive discipline guidelines in order to maintain order: 1. If a child is behaving inappropriately, the adult will tell the child specifically what he or she is doing that is not acceptable and state what the expected behavior is, e.g., “We do not throw blocks. We use blocks for building.” If this is not effective, the child should be guided to another activity. 2. If inappropriate behavior continues, the child may be placed in an area of the room where he or she will work alone, away from the other students for a brief period of time, the number of minutes not to exceed the age of the child. 3. If the child's disruptive behavior continues after these steps have been taken, the child may be taken to the Sunday School Superintendent, Education Ministry Coordinator, or other responsible adult. If a child must be removed from a classroom or other activity, the situation will be discussed with his or her parents. 4. If misbehavior occurs at an offsite location, the parent may be called to pick up the child. 5. In no case is an adult permitted to physically or verbally abuse a child who is misbehaving.

Permission Slips Children must have parental or guardian permission in advance to participate in any overnight activity or activity that takes place away from Good Shepherd’s grounds. Permission must be given in writing and signed by a parent or guardian. It must identify the name and date of the activity in which the child will be participating.

Transportation A. It is recommended that children be transported in groups rather than alone for church-sponsored activities. A child's parent or guardian may give permission for an unaccompanied trained adult to drive a single child or children to or from a church-sponsored activity. Parental permission for transportation as part of a planned event should be obtained in writing. B. Children legally required to be buckled into a car seat or booster seat must be transported using the appropriate safety seat. All other passengers shall wear a safety belt while in the vehicle. C. This policy is not intended to prohibit staff or adult volunteers from offering a ride home to children in an emergency situation. The adult shall make reasonable attempts to contact parents or guardians prior to providing the ride. The adult providing the ride shall inform the child’s parents of the expected departure, travel, and arrival times. The child or children shall ride in the backseat. D. No person under the age of 21 shall drive other children as part of a church activity.

Overnight Activities A. Whenever Good Shepherd children are involved in church-sponsored overnight activities, leaders must ensure that children are given appropriate privacy in the areas of sleeping, changing, and bathing. Specifically, an adult must never be permitted to sleep together in the same room or tent with a single child (without observing the two-adult rule), unless the adult is the parent of the child. B. Children and adults must never be permitted to bathe in the same facility at the same time. Similarly, children of the opposite gender must not be permitted to change or bathe together. C. Children of the opposite gender are not allowed to sleep in the same room together, unless they are siblings and a parent has requested this sleeping arrangement. Children of the opposite gender may

Good Shepherd Lutheran Church  100 W. Luray Avenue  Alexandria, VA 22301  Child Protection Policy 6 Updated May 9, 2012 only be permitted to sleep in the same room if an entire group of children, supervised by at least two trained adults, are sleeping in one big room together (e.g., at the Winter Lock-in). In these group sleepover situations, parents will be informed of the sleeping arrangements in advance and asked to give explicit permission for their child’s participation in these events. The required written permission slip from a parent or guardian must expressly acknowledge that the activity is coed. Overnight coed activities must be chaperoned by at least one approved and trained male adult and at least one approved and trained female adult. Adults participating in overnight activities are required to submit to a criminal background check with favorable results.

Digital Privacy A key ingredient for a safe and healthy experience is the respect for privacy. Advances in technology have enabled new forms of social interaction that may extend beyond the appropriate use of cameras or recording devices. A. To ensure full participation and the opportunity for a positive experience, children may be prohibited from bringing handheld electronic devices (e.g., cell phones, laptops, iPods, tablets, etc.) to youth events or other church-sponsored functions. B. Children and adults shall not send sexually explicit or suggestive texts, images, videos, or other content electronically. Children and adults shall not post sexually explicit materials on websites or social media sites. C. Children and adults can opt out of having their photos appear on the Good Shepherd website to protect privacy.

Chapter 5. Reporting and Responding to Abuse A. Anyone who witnesses or learns of the physical or sexual abuse of a child shall immediately report it to the police and then notify the Pastor and the Coordinator of Education Ministry. A person may learn of the physical abuse by direct observation or by being told of the abuse by the victim or perpetrator.

Added 5/31/2012 from “Suffer the Children” by Victor Vieth) Don’t investigate – report When a child makes an outcry of abuse, many faith organizations decide they need to conduct a preliminary assessment or investigation to determine if the allegation is plausible before reporting the matter to the police. This is problematic for four reasons. First, it is unlikely that any church or other faith institution has forensic interviewers specifically trained to speak with a child about sexual abuse, police officers skilled at interrogating child sexual abuse suspects or mental and medical health professionals who can document physical and psychological injuries resulting from abuse. Simply stated, the church is not specifically trained to assess an allegation of child abuse and thus should refer the matter to the local authorities who are specifically trained.

Second, any delay in reporting may result in the loss of critical evidence.35 Evidence on the child’s body, for example, will absorb, transfer or be washed away. Lubricants, pornography, sexual toys or other objects used in the abuse of the child may be destroyed. The perpetrator may use any delay to pressure the child or others to minimize or recant an allegation.36 Third, any delay in reporting is likely a violation of the law. In most states, churches and other organizations or professionals serving youth are mandated to report to the authorities any reasonable suspicion of abuse.37 Fourth, a church conducting an incompetent investigation that taints the memories of witnesses, results in the loss of evidence, or that provides the perpetrator with an opportunity to threaten or pressure one or more victims into silence may, on that basis alone, expose itself to liability. This is because an incompetent investigation may fail to detect an actual abuser. If the abuser continues to offend, which is likely, the church conducting the original investigation may be held responsible. B. Anyone who suspects any physical, sexual, or emotional abuse of a child shall report it immediately to the Pastor and the Coordinator of Education Ministry. The Report of Suspected

Abuse form (Appendix E) shall be used to document details and gather information. If the adult involved is the Pastor or the Coordinator of Education Ministry, then the Congregation Council President shall be notified. A person may suspect abuse by noting signs of abuse or by being told of abuse by another person. Some signs of sexual abuse are included in Chapter 6 of this document. Other examples of inappropriate behaviors or policy violations include seeking private time with children that is outside the scope of the programs at Good Shepherd, taking children on outings or overnight trips without other adults, swearing in front of children, making suggestive comments to children, or putting volunteers in positions to work with children without the required application or screening. C. An alleged perpetrator will be removed from any position involving contact with children at Good Shepherd until the allegation is resolved. The Pastor or Coordinator of Education Ministry and the Congregational Council President (when necessary) will maintain a confidential written record of each such report and will use appropriate judgment in designating a person or a team to gather additional information. During the information gathering, the Pastor will notify parents or guardians of alleged victims and those accused of allegations, as necessary, and will make proper reports to government and law enforcement authorities. It is Good Shepherd's policy to forward reports of child abuse to the appropriate governmental authority, as required by state law and church regulations. Good Shepherd will cooperate fully with government authorities in the investigations of allegations of child abuse. All persons involved in reporting or investigating any alleged incident of abuse shall hold information received in strict confidence, subject to such disclosures as are required under church procedures or by law.

D. Cases involving allegations of misconduct by a rostered member of the ordained clergy or rostered lay person in this congregation shall be promptly reported to the Bishop of the Metropolitan Washington D.C. Synod. Phone: 202-822-1901 Fax: 202-822-1902 Email: metrodcelca metrodcelca.org.

E. Church staff and volunteers are required to report known or suspected abuse of children to the appropriate state authorities. Failure to report suspected abuse of children may be a crime. Reports may be made confidentially or anonymously. Every state provides immunity from civil liability for persons required to report suspected abuse in good faith and without malice. Simply stated, “in good faith” means that the person submitting the report believes what he or she is reporting to be true.

Chapter 6. Signs of Child Sexual Abuse Following are some common signs of child sexual abuse that should be reported: Physical Signs: Unusual lacerations and bruises, Irritation, pain or injury to the genital area, Difficulty with urination, Discomfort when sitting, Torn or bloody underclothing, Venereal disease. Behavioral Signs: A sudden change in behavior, Nervous or hostile behavior toward adults,

Avoiding a person or situation that the child would normally have been involved in, Sexual self-consciousness, “Acting out” of sexual behavior. Verbal Signs: “______does things to me when we're alone", "I don't like to be alone with ______,” “______fooled around with me," “______says mean things to me.”

For additional information on signs of abuse, see the brochure “Recognizing Child Abuse and Neglect: Signs and Symptoms” published by the Child Welfare Information Gateway and the U.S. Department of Health and Human Services.

Appendix A. A Letter from the Pastor Dear Friends, Good Shepherd Lutheran Church, like other voluntary, religious, educational, and social service organizations, is concerned with difficult and sensitive issues relating to personal ethics and sexual misconduct, especially as these relate to children in our midst. Churches are by nature trusting institutions, which have traditionally accepted the services of anyone expressing an interest in working as a volunteer with children. While asking sensitive questions of potential youth workers, teachers or anyone closely involved with our children can be seen as distasteful and offensive, not doing so can make a church extremely susceptible to incidents of child abuse or molestation. A single incident involving a child, or even an adult, devastates the individuals involved, and can do the same to the entire church community. Because Good Shepherd Lutheran Church is concerned for the welfare of all its members, beginning with the youngest infant, we have worked to create a “Youth Protection Policy” which though relatively simple, seeks to take effective steps designed to reduce the likelihood of abuse in our church. The goal of this Policy is to assure our church is a safe place for children, youth, and all of our members and guests. To that end, a Youth Protection Policy has recently been adopted by our Church Council. All adults participating in programs involving significant contact with children will be contacted and asked to read the policy and to sign a statement indicating they have done so. We see this as a proactive approach toward protecting our children and the adults that generously give of their time to work with the children. I encourage you to speak with me or Denise Steene if you have questions or comments about the Policy. We continue to seek our Lord’s Spirit and guidance as our life together as a caring and responsible community of faith continues to deepen in the months and years ahead. Yours in Ministry Together, Ray W. Michener

Interim Pastor May 9, 2012

Appendix B. Good Shepherd Lutheran Church Application to Work with Children DATE of APPLICATION:

This application is a confidential, mandatory part of a process to help the church provide a safe, nurturing environment for our children. Persons responsible for the supervision and care of our children are in a special position of trust and confidence. Therefore, persons seeking to work with children at Good Shepherd Lutheran Church must complete this application. PERSONAL INFORMATION (Please attach photo identification, e.g., copy of driver's license) NAME

DRIVER’S LICENSE #

MAILING ADDRESS

CITY STATE ZIP CODE

TELEPHONE # (Home) (Cell) (Work)

EMAIL ADDRESS

How long have you been attending Good Shepherd Lutheran Church, Alexandria, VA? Are you 18 years or older? No Yes Have you ever been convicted of any criminal offense? No Yes Have you plead guilty or “no contest” to any criminal offense? No Yes Have you ever been charged with or convicted of child neglect? No Yes Have you ever been charged with or convicted of physical or sexual abuse of children or adults? No Yes Have you plead guilty or “no contest” to any neglect or abuse offense? No Yes Have any complaints or allegations of misconduct involving children ever been made against you? No Yes If you answered “yes” to any of the above questions, please explain, including in which state the conviction or charge occurred (use the back side of this application or a separate sheet of paper, as needed):

CHURCH OR YOUTH WORK EXPERIENCE Please provide the names and addresses of churches attended on a regular basis during the last 5 years. List all previous church and non-church work involving young people include the organization, address, type of work performed, and dates (use the back of this application or additional paper, as needed).

List any talents, training, education, etc. that have prepared you to work with young people (use the back of this application or additional paper as needed).

PERSONAL REFERENCES Please furnish personal references from churches, schools, community and civic organizations where past work with children was done, if there is no previous work with children, include volunteer work or other activities.

NAME TELEPHONE

ADDRESS

Type of work done:

NAME TELEPHONE

ADDRESS

Type of work done:

NAME TELEPHONE

ADDRESS

Type of work done:

I understand that the staff of Good Shepherd Lutheran Church may contact the churches and references I have provided as part of the process of reviewing this application. I hereby release from any liability any person or organization that provides information. I certify that the information I have provided is true and correct. If it is found that the answers given are untrue, I understand it may be cause for dismissal.

APPLICANT'S SIGNATURE:

Appendix C. Reference Check Form CONFIDENTIAL APPLICANT NAME REFERENCE CONTACTED NAME OF PERSON CONTACTING THIS REFERENCE METHOD OF CONTACT: telephone, letter, personal conversation

“Hello, my name is ______and I am calling on behalf of Good Shepherd Lutheran Church in Alexandria, Virginia. (Name of applicant name) ______applied to work with children at Good Shepherd Lutheran Church, listed you as a reference, and gave us written permission to contact you. Would you please answer the following questions to the best of your ability? This should only take a few minutes and is very important to our church programs. Thank you.”

QUESTIONS: A. How long have you known the applicant?

B. In what capacity?

C. Based on your experience, would you say that the applicant would work well with children? Why or why not? Prekindergarten

Grades K to 6:

Junior high:

Senior high:

D. Are you aware of any allegations of child abuse?

E. Are you aware of any problems that would affect his/her work with children?

F. Would you entrust your child to this person?

G. Any other comments?

SIGNATURE: DATE:

Appendix D. Child Protection Policy Acceptance Statement

Please read the copy of the Good Shepherd Lutheran Church Child Protection Policy provided to you. Please sign below to indicate that you have read and understood the Policy and agree to comply with the policy and procedures outlined therein when working with children.

I, (print name) ______, accept the responsibility to nurture the Christian faith and well-being of the children of Good Shepherd Lutheran Church and to care for them as Christ cares for me. “Jesus said, “Whoever welcomes a child, welcomes me.” (Matthew 18:5). Children are our present and our future, our hope, our teachers, our inspiration. They are full participants in the life of the church and in the realm of God. Jesus also said, “If any of you put a stumbling block before one of these little ones, it would be better for you if a great millstone were fastened around your neck and you were drowned in the depth of the sea.” (Matthew 18:6). I have read and understood the Good Shepherd Lutheran Church Child Protection Policy and accept it. I promise to exhibit appropriate behavior and conduct when working with children. I hereby affirm that I have not resigned from or been terminated from a position for reasons relating to abuse or misconduct, as defined in the Policy statement. I further affirm that I am not a registered sex offender nor do I have any pending or resolved cases with the civil authorities concerning the welfare of children. I affirm that I will not use my position of trust in the church to abuse or harm any child.

I HAVE READ and UNDERSTAND and AGREE TO ABIDE BY the Child Protection Policy of Good Shepherd Lutheran Church.

Signature Date

Contact Information NAME

MAILING ADDRESS

CITY STATE ZIP CODE

TELEPHONE # (Home) (Cell) (Work)

EMAIL ADDRESS

Appendix E. Report of Suspected Abuse 1) Name of adult observing or receiving disclosure of abuse or suspected abuse:

2) Date and time disclosure was given or abuse was observed: 3) Place disclosure was given or abuse was observed:

Brief notes: 1. Victim's name: 2. Victim's age: 3. Victim’s date of birth: 4. Date of initial conversation with victim: 5. Time of initial conversation with victim: 6. Place of initial conversation with victim:

Victim's statements (attach additional sheets as needed):

Name of accused: Position and status (paid staff, volunteer, or other) of person accused of abuse: Date/time/place of initial conversation:

Notes of conversation (please attach additional sheets as needed):

Result of information gathering: Asked to step down from activities with children at Good Shepherd Suspension date/time: Notes of suspension:

Information reported to police and/or other appropriate authorities Asked to continue activities with children at Good Shepherd.

Signed:______Date______

Appendix F. Confidential Notice of Concern Individual(s) of Concern: Date of occurrence: Time of occurrence: Type of Concern:  Inappropriate behavior with a child or youth  Policy violation with a child or youth  Possible risk of abuse  Other concern:

When answering the questions below, please attach additional sheets as needed. Describe the situation: What happened, where it happened, when it happened, who was involved, who was present, who was notified?

If reported to the local or state police, what was their recommendation about investigating? Has this situation ever occurred previously? Is so, what action was taken? How was the situation handled, who was involved, who was questioned, were police called?

What is the follow-up plan? Does anyone else need to be notified? Will the situation need monitoring? Would you like someone to call you to discuss this situation?

If willing, please include the following information: Submitted by: (Please print) Telephone number: Address: Date: Signature:

------Reviewed by: Date:

Model Policies for the Protection of Children and Youth—April 2004 http://www.episcopalchurch.org/documents/model_policies.pdf

Appendix G. Additional Locations to Seek Information

 State Criminal Records and Sex Offenders Registry Information Virginia Agency Virginia State Police, 7700 Midlophian Turnpike, Richmond, VA 23235 (804) 674-2000; www.virginiatrooper.org

 Criminal Background Check Criminal background records are obtained through either name and date of birth checks or fingerprint checks.  Sex Offender Registry The Sex Offender Registry hotline is (804) 674-2000.

 Virginia Department of Social Services Civil Registry (for neglect, etc.)

 State Child Abuse Reporting Statute Websites - Virginia www.dss.state.va.us

 For more information about where and how to file a report, contact your local child protective services agency or police department. An additional resource for information and referral is the Childhelp® National Child Abuse Hotline (800.4.A.CHILD).

Appendix H. Event/Trip Adult Expectations and Information Letter Thanks for volunteering your time and energy to the Good Shepherd youth. If you have any questions about the event you are attending, please ask so we can clarify. We will provide as much information about the event as is available through emails and conversation. One of the main purposes of youth events is to provide an opportunity for caring adults to connect with youth and to build relationships that will last beyond the end of the event. You will be asked to be more than a “chaperone” who sits on the sidelines; we are looking for “shepherds”--adults who will open up and walk alongside the youth throughout your time together. As you open yourself and fully participate, you may find yourself gaining as much from this experience as the youth. Commitments:

o Complete child protection training. This is required for all adults working with youth.

o Sign a “Child Protection Policy Acceptance Statement.”

o Complete an application for a background check if you will be staying overnight with the youth.

o Attend any pre-event meetings, if scheduled.

o Help with event preparations such as planning, shopping, etc.

o Participate with the youth during the entire duration of the event or trip.

A Shepherd’s Responsibilities:

o Be a triple-A adult—authentic, available, and affirming.

o Try your best to meet and engage all youth equally.

o Be on time to all scheduled meetings, happenings, etc.

o Participate in all scheduled happenings. If you feel comfortable leading a prayer, devotion, etc., please do so.

o Drive, if needed. All drivers must be age 21 or older.

o If you have a camera and can take photos, it is always nice to document the event.

Thank You! Have Fun!

BACKGROUND CHECK AUTHORIZATION FORM I hereby authorize Lexis Nexis/ChoicePoint Services Inc., on behalf of Good Shepherd Lutheran Church, Alexandria, Virginia, to procure a consumer report (known as an investigative consumer report in California) which I understand may include information regarding my character, general reputation, personal characteristics, or mode of living. This report may be compiled with information from courts record repositories, and any other source required verifying information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living.

Full Name______

Social Security Number ______Date of Birth ______

Current Street Address______City______State ______Zip Code ______

Home Phone ______Cell Phone ______

E-mail ______

Current Congregation Name______City______State______Previous Addresses (past 5 years, including county of residence) ______

Signature______Date______

BACKGROUND VERIFICATION DISCLOSURE The Metropolitan Washington, D.C. Synod of the Evangelical Lutheran Church in America will obtain an investigative consumer report. The investigative consumer report may include information regarding your character, general reputation, personal characteristics or mode of living. The following Consumer Reporting Agency will prepare the report: ChoicePoint Services Inc. 1000 Alderman Dr. Alpharetta, GA 30005

Good Shepherd Lutheran Church  100 W. Luray Avenue  Alexandria, VA 22301  Child Protection Policy 19