Volunteer Application

If you haven’t already, please take a moment to review our Statement of Faith & Core Values before submitting your application. We ask that all of our volunteers agree to the statements in order to best serve our Guests with the love of Jesus.

Volunteer Application Form

Statement of Faith and Core Values*
- I have read and agree with the Barren Heights Statement of Faith and Core Values.
Have you volunteered at a retreat within the past 2 years?*
- Yes
- No
*Please note that Ministry Safe Training & Background Checks, for everyone over the age of 18 years old, need to be updated every TWO YEARS.*
If you are a first time volunteer, or you have not volunteered with Barren Heights in the past two years, all family members, over the age of 18, will be required to complete:
1. Ministry Safe Training (Sexual Abuse Awareness Course)
2. Background Check
3. Attend one of our in person training nights.
Choose your desired retreat weekend:*
Choose your desired alternative retreat weekend:*
How would you like to volunteer?*
Retreat A: June 2-4
How would you like to volunteer?*
Retreat B: June 9-11
How would you like to volunteer?*
Retreat C: June 16-18
How would you like to volunteer?*
Retreat D: June 23-25
How would you like to volunteer?*
Retreat E: July 7-9
How would you like to volunteer?*
Retreat F: June 14-16
How would you like to volunteer?*
Retreat G: July 21-23
How would you like to volunteer?*
Retreat H: July 28-30
How would you like to volunteer?*
Retreat I: August 4-6
How would you like to volunteer?*
Retreat J: August 18-20
How would you like to volunteer?*
Retreat K: August 25-27
How would you like to volunteer?*
Retreat L: September 8-10
How would you like to volunteer?*
Retreat M: September 15-17
How would you like to volunteer?*
Retreat N: September 22-24
How would you like to volunteer?*
Retreat O: September 29-October 1
How would you like to volunteer?*
Retreat P: October 6-8
How would you like to volunteer?*
Retreat Q: October 13-15
Family/Group Information
Family/Group Name
Phone
Email
Address*
Street Address Address Line 2 City State ZIP Code
What church does your family attend?

Please list church name and city the church is located in.
References
Who referred you to Barren Heights?
First Last
Church Affiliated Reference*
First Last
Church Affiliation*
Church Referrer's Phone*
Church Referrer's Email*
Personal Reference*
First Last
Personal Referrer's Phone*
Personal Referrer's Email*
What is your relation to this person?*
How long have you known this person?*
Volunteer Information
Please explain why you have an interest in serving at Barren Heights:
How many volunteers do you want to register (including yourself)?
Volunteer 1 (Primary Contact Person)
First Last
Volunteer 1: T-Shirt Size
Volunteer 1: Date of Birth
Month
Day
Year
Volunteer 1: Employment Status
Volunteer 1: Employer
Volunteer 1: Occupation/Job Title
Volunteer 1: Phone
Volunteer 1: Email
Volunteer 1: Food Allergies/Restrictions:
Volunteer 1: Special Gifts/Talents/Experience:
Volunteer 2
First Last
Volunteer 2: T-Shirt Size
Volunteer 2: Date of Birth
Month
Day
Year
Volunteer 2: Employment Status
Volunteer 2: Employer
Volunteer 2: Occupation/Job Title
Volunteer 2: Phone
Volunteer 2: Email
Volunteer 2: Food Allergies/Restrictions:
Volunteer 2: Special Gifts/Talents/Experience:
Volunteer 3
First Last
Volunteer 3: T-Shirt Size
Volunteer 3: Date of Birth
Month
Day
Year
Volunteer 3: Employment Status
Volunteer 3: Employer
Volunteer 3: Occupation/Job Title
Volunteer 3: Phone
Volunteer 3: Email
Volunteer 3: Food Allergies/Restrictions:
Volunteer 3: Special Gifts/Talents/Experience:
Volunteer 4
First Last
Volunteer 4: T-Shirt Size
Volunteer 4: Date of Birth
Month
Day
Year
Volunteer 4: Employment Status
Volunteer 4: Employer
Volunteer 4: Occupation/Job Title
Volunteer 4: Phone
Volunteer 4: Email
Volunteer 4: Food Allergies/Restrictions:
Volunteer 4: Special Gifts/Talents/Experience:
Volunteer 5
First Last
Volunteer 5: T-Shirt Size
Volunteer 5: Date of Birth
Month
Day
Year
Volunteer 5: Employment Status
Volunteer 5: Employer
Volunteer 5: Occupation/Job Title
Volunteer 5: Phone
Volunteer 5: Email
Volunteer 5: Food Allergies/Restrictions:
Volunteer 5: Special Gifts/Talents/Experience:
Volunteer 6
First Last
Volunteer 6: T-Shirt Size
Volunteer 6: Date of Birth
Month
Day
Year
Volunteer 6: Employment Status
Volunteer 6: Employer
Volunteer 6: Occupation/Job Title
Volunteer 6: Phone
Volunteer 6: Email
Volunteer 6: Food Allergies/Restrictions:
Volunteer 6: Special Gifts/Talents/Experience:
Volunteer 7
First Last
Volunteer 7: T-Shirt Size
Volunteer 7: Date of Birth
Month
Day
Year
Volunteer 7: Employment Status
Volunteer 7: Employer
Volunteer 7: Occupation/Job Title
Volunteer 7: Phone
Volunteer 7: Email
Volunteer 7: Food Allergies/Restrictions:
Volunteer 7: Special Gifts/Talents/Experience:
Volunteer 8
First Last
Volunteer 8: T-Shirt Size
Volunteer 8: Date of Birth
Month
Day
Year
Volunteer 8: Employment Status
Volunteer 8: Employer
Volunteer 8: Occupation/Job Title
Volunteer 8: Phone
Volunteer 8: Email
Volunteer 8: Food Allergies/Restrictions:
Volunteer 8: Special Gifts/Talents/Experience:
Volunteer 9
First Last
Volunteer 9: T-Shirt Size
Volunteer 9: Date of Birth
Month
Day
Year
Volunteer 9: Employment Status
Volunteer 9: Employer
Volunteer 9: Occupation/Job Title
Volunteer 9: Phone
Volunteer 9: Email
Volunteer 9: Food Allergies/Restrictions:
Volunteer 9: Special Gifts/Talents/Experience:
Volunteer 10
First Last
Volunteer 10: T-Shirt Size
Volunteer 10: Date of Birth
Month
Day
Year
Volunteer 10: Employment Status
Volunteer 10: Employer
Volunteer 10: Occupation/Job Title
Volunteer 10: Phone
Volunteer 10: Email
Volunteer 10: Food Allergies/Restrictions:
Volunteer 10: Special Gifts/Talents/Experience:
In Case of Emergency (ICE)
Emergency Contact*
Please provide a contact that will not be attending with you.
First Last
Relation to Emergency Contact*
Phone Number*
For our records
How did you learn about Barren Heights?
Which group?
Which therapist?
Who can we thank?
Could you be specific?
All application information is kept confidential. Application information may be shared with retreat volunteers so they are better equipped to serve your family. This information will not be distributed or used for marketing purposes.

Hold Harmless Agreement

By checking the boxes below you are agreeing on behalf of your family to an electronic signature.
Please check if you agree with the following statements:*
- Select All
- I give my consent that the information given at registration may be communicated with leaders and volunteers for the purpose of being equipped to provide the best care and assistance possible to my family.
- I give my consent that photographs, interviews and audio/visual recordings during the course of the event may be used by Barren Heights for training, promotion, and fundraising.
- I release Barren Heights, its directors, and volunteers, and the Retreat Center and Community Center facility from all actions, damages, or personal injuries which may occur to me or a member of my family. I understand that in the event of a minor injury, I, or a member of my family may receive first aid treatment. I will be informed as soon as possible of any injury or condition of one of my family members and will be responsible thereafter for their care. In the event of an emergency, injury, or illness, emergency medical services and I will decide the best course of action. If the leaders are unable to reach me, I authorize them to take whatever action is necessary for the safety and health of my family members.
- I understand that in order for everyone to experience a sense of calm and peaceful relaxation, the Retreat Center and Community Center is an alcohol, drug, and smoke-free environment. Use of cell phones is discouraged except when necessary.
- I acknowledge that Barren Heights cannot guarantee that I will not become sick/infected with the Coronavirus/Covid-19, Flu, Common Cold, and other spreadable illnesses. I understand that the risk of becoming exposed to and/or infected may result from the actions, omissions, or negligence of myself and others.
- I voluntarily seek services provided by Barren Heights and acknowledge that I do so at my own risk and the risk of my family.
- I hereby release and agree to Barren Heights’ hold harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss. I understand that this release discharges Barren Heights from any liability or claim that I, my heirs, or any personal representatives may have against them with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to any services rendered. This liability waiver and release extends to Barren Heights together with all owners, partners, volunteers and employees.
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Barren Heights Community Center
11420 Watterson Court #800
Louisville, KY 40299

Office Hours:
Monday/Tuesday/Thursday, 9 a.m.–3 p.m. ET
(502) 327-9495

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