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Grace Safety Team Application

Thank you for your interest in the Grace Church Safety Team. Please fill out the form below to the best of your ability and one of the safety leadership team will get in contact with you. Thank you for your time and interest.

Today's Date (required)

First Name (required)

Last Name (required)

Birthdate (required)

Street Address (required)

City (required)

State (required)

Zip (required)

Phone Number (required)

Email Address (required)

CPR Certified (required)

Expiration Date (If YES)

First Aid Certified (required)

Expiration Date (If YES)

Adv Medical (required)

Expiration Date (If YES)

Please let us know about your experience that you have in security, law enforcement, military and medical. REMEMBER you do NOT have to have experience this just gives us information. Tell us a little about yourself.
(required)

For a printable version, please click below:

Safety Team Application

When completed, either mail your application to: Grace Church, 4172 East Allison Rd. Camby, IN 46113, bring it to the Info Center on Sundays, or email to safety@discovergrace.net.

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