S a f e t o G r o w – Reference Form

Private and Confidential

 Section 1 (To be completed by church)

Name of volunteer ……………………………………………………………………………………………

has applied to work with children/young people aged

…………………………………………………………

in ………………………………………………………………………………………….… (name of organisation)

 

His/her responsibilities will include:

………………………………………………………………………………

………………………………………………………………………………………………………………………

Name of referee ……………………………………………………………………………………………………

 

Section 2 (To be completed by the referee)

What is your relationship/connection with the volunteer?

………………………………………………………

How long have you known the volunteer? ………………………………………………………………………

What personal experience do you have of the volunteer’s ability to work with/relate to children and/or Young People?

…………………………………..………………………

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

 

What are the gifts and experience the volunteer will bring to the role? ………………………………………

………………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………

 

Please comment on the volunteer’s honesty and reliability ……………………………………………………

………………………………………………………………………………………………………………………

 

To your knowledge, is there anything about the volunteer’s past behaviour, their character or attitude that gives you any cause for concern about their suitability to work with children and/or young people?

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

 

Are there any other comments you would like to make about the volunteer?

………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

 

(Please continue any of your answers over the page if necessary.)

 

Signed …………………………………………………………….. Date ………………

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