Candlelight Christian Fellowship

Benevolence Request Form

Candlelight is a church – a group of individuals just like you, who have found help in life and living through the grace and love of our living Savior, Jesus Christ. Our desire is to provide for your immediate physical needs and most importantly, to assist your spiritual well being.

In order to participate in our work/benevolence program, please complete the following form.

Name:___________________________________________Date:_____________

Married?  Y/N     Name of Spouse:______________________________________

Children:

Name: ___________________________________________Age:_____________

Name: ___________________________________________Age:_____________

Name: ___________________________________________Age:_____________

Name: ___________________________________________Age:_____________

Current Address: ___________________________________________________

Phone number (s): __________________________________________________

Social Security # ________________________D/L # ______________________

Do you or your spouse have outstanding warrants?  Y/N

Are you in trouble with the law in any way?  Y/N

If yes, please explain briefly: ____________ ____________________________

Briefly state what circumstances lead up to your current situation: __________________________________   

My immediate need is: (gas, food, rent, lodging etc.)

___________________________________________________________________________________

Do you have transportation?  Y/N

Do you have valid Automobile Insurance?  Y/N

Are you currently affiliated with any other church or organization?   Y/N

(If yes, who?) ______________________________________________________

Have you sought assistance with any other church or organization?  Y/N

(If yes, who?) ______________________________________________________

What assistance was offered or obtained? ____________________________________________________

Are you willing to work in our work program for your assistance?  Y/N

Please list two personal references.

 Name: ____________________________________Phone#_________________

Relationship:  Friend_____________ Family_____________ Other____________

Name: ____________________________________Phone#__________________

Relationship:  Friend_____________ Family_____________ Other____________

How did you hear about Candlelight?____________________________________ ________________________________________________________________

Any additional Comments you would like to share?___________________________________________________________    __________________________________________________________________________________

 Benevolence Worker

Non Employment Document

I understand that I am receiving assistance in exchange for labor and that in no way is this exchanged labor to be considered a job or employment and that there will be no exchange of cash.

__________________________               ___________________________

Benevolence Worker                                   Witness

__________________________

Date

Waiver of Liability

 I, _______________ (Benevolence worker,) hereby release Candlelight Christian Fellowship from any and all liability connected with my participation in church benevolence duties assigned to me.  I acknowledge that I am participating in these activities on my own time and of my own choice and assume all risk in connections thereto.  I hold Candlelight Christian Fellowship harmless for any injuries sustained while performing these duties.

_________________________                 ___________________________

Benevolence Worker                                   Witness

_________________________

Date