Love, Joy, Peace...

The Agency Community Church collects the requested data for the following purposes:

parental consent for minor to volunteer

emergency contact info

determine volunteer eligibility (which may include a background check as a separate request)


If you have any questions or concerns, please call the church at 641-932-5216.

Name (Required)
Email Address (Required)
Your child's name
Your child's birthdate
Your Phone Number
Emergency Contact
In the event of an emergency, who do we contact? Phone number?
Allergies or Medical Info
Solve 2 + 8 = ?