Read and initial each item to signify your agreement to comply with the statement.  Please return to Grace Lutheran Church office.  (Please make a copy to keep for your records)

____ I agree to do my best to prevent abuse and neglect among children and youth involved in

          Grace Lutheran Church activities and programs.

____ I agree not to physically, sexually, or emotionally abuse or neglect a child or youth.

____ I agree to comply with the policies for General Conduct for Staff and Volunteers as defined in the

          Grace Lutheran Church policy and procedure manual.   p. 2-3.

 ____ I agree to comply with the Guideline for Appropriate Affection (Appendix A) with children and   


____ In the event that I observe any inappropriate behaviors or possible policy violations with children

          and/or youth, I agree to immediately report my observations.

____ I acknowledge my obligation and responsibility to protect children and/or youth and agree to

          report known or suspected abuse of children and/or youth to appropriate pastoral leadership and

          state authorities in accordance with Grace Lutheran Church Policy and Procedure Manual  p. 4.

 ____ I understand that Grace Lutheran Church will not tolerate abuse of children and/or youth and

          agree to comply in spirit and in action with this position.[1]

____ I agree to and understand all policies and procedures as defined and outlined in the Grace

          Lutheran Church Policies and Procedure Manual.



Signature ________________________________________________  Date ___________


Print Name __________________________________________________

[1] Church Pension Croup p. 17



Appendix 2

Appendix A

Guidelines for Appropriate Affection[2]       

Grace Lutheran Church is committed to creating and promoting a positive, nurturing environment for our children’s and youth’s ministries that protect our children and youth from abuse and our staff and volunteers from misunderstandings.  When creating safe boundaries for children and youth, it is important to establish what types of affection are appropriate and inappropriate; otherwise that decision is left to each individual.  Stating which behaviors are appropriate and inappropriate allows staff and volunteers to comfortably show positive affection in ministry, and yet identify who are not maintaining safe boundaries with children or youth.

The following guidelines are to be carefully followed by all staff and volunteers working around or with children and youth.

  1. Love and affection are part of church life and ministry.  There are many ways to demonstrate affection while maintaining positive and safe boundaries with children and youth.


    Some positive and appropriate forms of affection are listed below:

  • Brief hugs initiated by children or youth (side hugs are preferred).

  • Pats on the shoulder or back.

  • Handshakes.

  • “High-fives” and hand slapping.

  • Verbal praise.

  • Touching hands, faces, shoulders and arms of children or youth.

  • Arms around shoulders.

  • Holding hands while walking with small children.

  • Sitting beside small children.

  • Kneeling or bending down for hugs with small children.

  • Holding hands during prayer.

  • Pats on the head when culturally appropriate.


  1. The following forms of affection are considered inappropriate with children and youth including, but not limited to, ministry settings:

  • Inappropriate or lengthy embraces.

  • Kisses on the mouth.

  • Holding children first (1st) grade and older on the lap.

  • Touching bottoms, chest, or genital areas other than for appropriate diapering or toileting of infants and toddlers.

  • Showing affection in isolated areas such as bedrooms, closets, staff only areas, or private rooms.

  • Occupying a bed with a child or youth if child is not an immediate family member.

  • Touching knees or legs of children or youth.

  • Wrestling with children or youth.

  • Tickling children or youth.

  • Any type of massage given by child or youth to an adult.

  • Any type of massage given by an adult to a child or youth.

  • Any form of unwanted affection.

  • Comments or compliments (spoken, written, or electronic) that relate to physique or body development.  Examples would be, “You sure are developing” or “You look really hot in those jeans.”

  • Snapping bras or giving “wedgies” or similar touch of underwear whether or not it is covered by other clothing.

  • Giving gifts or money to individual children or youth.

  • Private meals (e.g. at the home, room, hotel room of a staff member, volunteer etc.) with individual children or youth.






[1] Church Pension Croup p. 17

[2] Church Pension Group p. 11-12