TRC Pella

First name

Last name

Street address

City

State

Zip code

Phone

Email address

Please list two references, name and phone number.

Grade

• Senior

• Junior

• Sophomore

• Freshman

• 8th

• 7th

• 6th

Please check all days that you are available/willing to provide childcare.

• Sunday

• Monday

• Tuesday

• Wednesday

• Thursday

• Friday

• Saturday

Are you available/willing to drive to provide childcare? (ie. Oskaloosa, Montezuma)

• yes

• no

Please refer to the pay scale, then agree to the terms below.

All payment received from this service will be applied to the student's mission trip fund. If the student decides not to participate in a mission trip, the payment from the services provided will be forfeited.

• Yes, I agree to the terms of payment.

Students are responsible for filling out the Childcare Submission form online after each service provided. If forms are not filled out within the week, payment is forfeited.

• I agree to filling out a weekly form online and agree to the terms of payment.

I give permission for my student to participate in the childcare services for ministries (Groups, Revere, Healing Service) at Third Church. I acknowledge that my student will forfeit payment if he/she decides not to go on a mission trip, or does not turn in the required paperwork online. I hereby release Third Church, it’s staff and volunteers, from any and all liability.

• I, as the parent or guardian, agree to these terms.

Additional comments or questions.