S4.49 Form for Clerics/Religious who have Ministry with Children in an External Organisation

Section 1: To be completed by representative of external organisation/Church body

(INSERT NAME OF MEMBER OF CHURCH PERSONNEL) has ministry with children in (INSERT NAME OF EXTERNAL ORGANISATION/CHURCH BODY) as a (INSERT ROLE HELD). On behalf of (INSERT NAME OF EXTERNAL ORGANISATION/CHURCH BODY) I am happy to state that we have Safeguarding Policies and Procedures in place and that (INSERT NAME OF CHURCH PERSONNEL) is fully aware of and compliant with these.

SIGNED : ________________________________________________________

POSITION IN EXTERNAL ORGANISATION/CHURCH BODY: ________________________________________________________

DATE: ________________________________________________________
Section 2: To be completed by member of Church personnel ministering with children in external organisation/Church body

I, (INSERT NAME OF MEMBER OF CHURCH PERSONNEL) verify that I am aware of the Safeguarding Policies and Procedures in (INSERT NAME OF EXTERNAL ORGANISATION/ CHURCH BODY) and undertake to adhere fully to these Policies and Procedures.

SIGNED: ________________________________________________
DATE: __________________________________________________