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Draft Limited Access Agreement—Confidential

Checklist Format

Introductory paragraph in cases of allegation:

A serious complaint or allegation, now under review, has been made about you to the Sexual Misconduct and Abuse Response Team. While this complaint is being investigated, in order to protect the children and youth in our programs from potential risk, and in order to protect you from further suspicion, we ask you to abide by this interim agreement. Signing this document in no way constitutes a presumption or confession of guilt. This is a routine safety precaution, activated without prejudice toward particular individuals or circumstances. This document will be made known only to the Minister, the Religious Educator and the members of the Sexual Misconduct and Abuse Response Team. It will be kept in a locked file in the office

Introductory paragraph in cases of convicted sex offender:

The NAME OF CONGREGATION affirms the dignity and worth of all persons. We are committed to being a religious community open to those who choose to worship with us, especially in times of serious personal troubles. However, based on your background, we have concerns about your contact with children and youth in our congregation. The following guidelines are designed to reduce the risk to both you and them of an incident or accusation. We welcome you to our congregation and our membership but your participation will be limited in ways to ensure the safety of our children and to assure that you will not be subject to future accusations.

Agreement:

You understand that you will not be allowed to volunteer or chaperone events for children and adolescents, including children's religious education classes, talks with children/adolescents during worship, youth group, children's and adolescents' activities during intergenerational events, and driving children and young people.

The following activities checked "Yes" are activities that we feel are appropriate for your participation.

  • Worship services
    No ( ) Yes ( ) With support person* No ( ) Yes ( )
     
  • Coffee Hour
    No ( ) Yes ( ) With support person* No ( ) Yes ( )
     
  • Adult meetings with children in building, such as choir
    No ( ) Yes ( )
     
  • Adult meetings without children in building
    No ( ) Yes ( )
     
  • Have a key to the building
    No ( ) Yes ( )
     
  • Intergenerational church activities
    No ( ) Yes ( ) With support person* No ( ) Yes ( )
     
  • Intergenerational group outings such as ice skating, baseball games, etc
    No ( ) Yes ( ) With support person* No ( ) Yes ( )
     
  • Alone in building with minister or other staff
    No ( ) Yes ( )
     
  • Access to church computer
    No ( ) Yes ( )
     
  • Social activities in other member's homes with children present
    No ( ) Yes ( ) With support person* No ( ) Yes ( )
     
  • Other:
    • Activity:
      No ( ) Yes ( )
       
    • Activity:
      No ( ) Yes ( )
       
    • Activity:
      No ( ) Yes ( )

*A support person is a person who knows about your history/situation and has been designated by you with our approval to accompany you to activities where children and youth may be present.

I accept that the following people will be told of my circumstances in order for them to protect the children/young people for whom they care: INSERT NAMES AND/OR POSITION IN CONGREGATIONAL LEADERSHIP.

I have reviewed this covenant and agree to abide by its provisions. I agree that if I violate this agreement, I will be denied access to future church functions and church property.

I understand that this contract will be reviewed regularly every six months and will remain for an indefinite period.

Signature:

Date:

 

Witness:

Date:

 

Minister:

Date:

 

Director/Minister of Religious Education:

Date:

 

Board Chair:

Date:

 

For more information contact safecongregations @ uua.org.

This work is made possible by the generosity of individual donors and congregations. Please consider making a donation today.

Last updated on Friday, April 22, 2011.

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