This form is used to notify the office and administration of any problems with any individual you've encountered

during your ministry. This is required for your protection should an unfavorable event have taken place during

your meeting, outing or any other activity that represents New Life Church. Please submit this form in a timely

manner so that prompt action can be taken to protect you and the church. Thank you!.

Ministries or Persons Affected

 Ministry Name:          

 Leaders Name:          

 Date:                         

 Form Completed by:  

Person (s) Involved In Incident:

Please give as much information as possible in completing this form.