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Church & Pastoral
Board Member Review Form
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Breakaway Pastoral Reference
Breakaway Leader Applicant
NO. This applicant should not be considered for a chaperone for Breakaway.
YES. I recommend this applicant as a chaperone for Breakaway. This person is a spiritual leader, has a cooperative spirit and to my knowledge has not done anything that should disqualify them from leading young people.
I understand that checking this box constitutes a legal signature confirming that, to the best of my knowledge, the above information is complete and correct.
This field is for validation purposes and should be left unchanged.
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