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Sample Agreement to Teach Form

For Religious Educators and Youth Group Leaders





Cell phone:


I have read and understand our congregation's policies on keeping children, youth and vulnerable adults safe. These include: [put in by name]



I agree to uphold these principles in my work with [name of congregation] children, youth, adults, and families.

I have signed the Code of Ethics statement.

I affirm that I have never been accused of, convicted of, or pled guilty to any sexual crime. I also have not pled guilty to a lesser charge after having been charged with a sexual crime. I have never engaged in any form of child abuse, including sexual abuse. I have never been determined to have engaged in any sexual offenses in any civil, administrative, or ecclesiastical forum or other forum.

If there are any facts or circumstances in my background that call into question my being entrusted with the supervision, guidance, and care of children, youth, or vulnerable adults, I have met to review this information confidentially with the Minister and the Religious Educator.

Further, I agree to notify the Minster and the Religious Educator immediately should I be accused of sexual abuse, sexual offenses, sexual harassment, or other sexual improprieties in the time that I am working with children and youth in this congregation.