Share Your Heart Volunteer Chaplaincy Program
Membership Registration Application

This Application Is For: *

New Volunteer Chaplain

or Yearly Renewal

Location you are registering for? *

South Florida	SWFL - Lee, Collier, Charlotte, Hendry, Glades
North Florida - Tallahassee	NWFL - Pensacola

Applicant Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

County *

If you lived at the above current address for less than 7 years, please provide us with your former address here:

Street Address

City

State

Zip Code

County

Home Phone Number *

Cell Phone Number *

Email Address *

Polo-shirt size *

Date of Birth *

Sex: *

Male

Female

Hair Color: *

Eye Color: *

Height: *

Weight: *

Are you a citizen or resident of the United States *

Yes

No

Current Driver License or State ID #: *

State *

Did a Pastor, Church Leader or Chaplain recommend you? *

Yes

No

If yes, please provide Name and Organization: *

In Case of Emergency

In Case of an emergency notify: *

Relationship: *

Phone Number *

Acknowledgments

Please Initial each Item

(1) If you are convicted of a criminal act or any sexual misconduct, assault or any ethical misconduct then the SYHVCP will take appropriate disciplinary action up to and should include immediate discharge as a member of the Share Your Heart Volunteer Program.

Initials *

(2) As part of the application and or the yearly re-certification process, you hereby authorize the Share Your Heart Volunteer Chaplaincy Program or its designated investigating agency, the unrestricted right to have a criminal background check performed as part of your approval process if the information you provide is not complete or if it is in question.

Initials *

(3) All members should only wear our authorized uniform on official SYHVCP Business or in a time of crisis or in an act of disaster.

Initials *

(4) To be eligible for re-certification, you must take at least up to 6 hours of continuing education.

Initials *

(5) All I.D.'s lost or stolen MUST be reported IMMEDIATELY!

To our office: Tel: (786) 362-5870 or Email: betty@victoryforyouth.org

Initials *

(6) Purchase of training materials, uniforms, I.D,'s and any other item you may want or need is your responsibility and those items are not provided as part of certification process.

Initials *

I attest that all information provided on this application is accurate and agree to all 6 items above *

Acknowledge

Signature *

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Proper Use of Uniform (Polo or T-Shirt) and Identification

Uniforms have been an international tradition of all branches of Chaplains and the Share Your Heart Volunteer Chaplain Program requires the wearing of uniforms but only on approved SYH official business such as deployment and/or in an act of a disaster. Keep in mind that the SYH shirt bears the official badge of the Department of Children and Families authorizing those who wear it to go about the state’s business. A Chaplain NOT in uniform on official SYH business must wear the Volunteer Chaplain ID where it may be seen. In both cases you must abide by the DCF rules and keep your chaplaincy status renewed including a current background check and renewed I.D. If you no longer wish to remain active as an official SYH Chaplain and as a representative of DCF, it is mandatory that you return your shirt.

Wearing the uniform of a Chaplain automatically gains respect from others and from you, the Chaplain. The uniform we wear represents, in addition to DCF, God, our Children, our Families, the Share Your Heart Program, Victory for Youth, YOUR Church, the people you have sworn to serve and yourself.. Therefore the uniform of the SYHVCP shall never be worn in a manner or place that would bring disgrace or controversy. If you have a question about a situation being acceptable, then do not wear it.

As a Chaplain always remember that you have sworn an oath to all faiths and not all faiths share the same ideas and or rituals. We are all about our Father’s business, not ours. Bless you. *

I acknowledge and agree

Signature *

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Share Your Heart Volunteer Chaplain's Oath

It is my belief and declaration that I have been called to devote my time to the service of humanity without regard to race, gender, ideology, or religion. Through my own conscious choice I have chosen to manifest my calling through the form of a Volunteer Chaplain for the Share Your Heart Program.

As a Member of the Share Your Heart Volunteer Chaplaincy Program I recognize that every individual follows their own spiritual path. I vow to be respectful of all paths of faith and to honor an individual's personal journey towards enlightenment and truth. Further, I acknowledge the diversity of the people of our Community and I solemnly vow to carry out my duties as a Volunteer Chaplain of the Share Your Heart Program without prejudice or judgment of any kind. As a Member of the Share Your Heart Volunteer Chaplaincy Program I oblige myself to always do what is RIGHT. I vow to harm no one and shall adhere both to the laws of my nation and of my Creator. I declare that I freely and seriously take the vows as stated above under my own free will. Further, I understand that I am requesting certification and Membership in the Share Your Heart Volunteer Chaplaincy Program. I further understand that if accepted by the Share Your Heart Volunteer Chaplaincy Program I shall abide by the law.

I acknowledge and agree that in making these commitments that it is my understanding that “The desire to Share Your Heart is the result of your Heart acting in Love”. I vow to keep these commitments for as long as I am a member of the Share Your Heart Volunteer Chaplaincy Program. *

I acknowledge and agree

Signature *

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Thank you for your willingness to Share Your Heart!

Share Your Heart Volunteer Chaplaincy Program Membership Registration Application

Applicant Information

In Case of Emergency

Acknowledgments

Proper Use of Uniform (Polo or T-Shirt) and Identification

Share Your Heart Volunteer Chaplain's Oath

Share Your Heart Volunteer Chaplaincy Program
Membership Registration Application