“Our Saviour Lutheran Church welcomes children and is committed to making our church a safe place for children and young adults to grow and learn.”

Safe Sanctuary Policy

Our Saviour Lutheran Church

Johnson City, Tennessee

Our Saviour Lutheran Church welcomes children and is committed to making our church a safe place for children and young adults to grow and learn. It is our responsibility to be proactive in recruiting and training to find people with a gift for caring for children/young adults and also to protect those volunteers from false accusations. It is our responsibility to oversee all programs involving children to make sure there is a safe environment and to have a plan of response in place should an accusation arise.



Our purpose for establishing this Safe Sanctuary Policy and accompanying procedures is to demonstrate our absolute and unwavering commitment to the physical safety and spiritual growth of all children and youth.



As a Christian community of faith committed to ministry to and with children and youth, we pledge to conduct all our activities and ministries in such a way that assures the safety and provides for the spiritual growth of all children and youth entrusted to us. We will follow reasonable safety measures in the selection and recruitment of workers and we will be responsible in overseeing our programs and events and in training our staff, so that they are able and equipped to minister to children in Jesus’ name. We will report and respond to all suspected incidents of abuse as is required by Tennessee state law.



We adopt these minimum standards for our ministries with children and youth.

  1. Recruiting and Screening
  2. All workers with children and youth will have completed a Volunteer Application Form (Form I) listing standard contact information, their gifts for that ministry and three unrelated references.
  3. The pastor and/or Christian Education Ministry chairperson will interview all workers before they begin teaching. References may be contacted.
  4. All workers will demonstrate a participating relationship with OSLC of at least six months before being allowed to supervise children.
  5. We will conduct a Background Check and Child Abuse History Clearance on all new workers.
  6. Contact information of all applicant’s will be separately held in a non-confidential file. All CONFIDENTIAL PERSONNEL FILES shall be kept in a locked file on the church premises. Only the Pastor, the Christian Education chairperson and the Congregational President will have access to the confidential files
  1. Supervision
  2. Two-adult rule: There will be two unrelated adults in each Sunday school classroom. If this is not possible, there will be a roving teacher who moves amid the classroom during the program period.
  3. No person shall supervise an age group unless he/she is at least five years older than the oldest student.
  4. No person under 16 shall be considered as one of the two adults.
  5. Each room will have a window or the door will be left open at all times
  6. Training shall occur at least once a year and teachers shall be trained to recognize the signs of abuse. Teachers will retrain every three years.
  7. Registration materials for activities in which children are outside direct supervision of their parents/guardians shall require written permission forms that include pertinent health information in order to participate.
  8. If the participants are old enough to understand, they shall sign a covenant of participation listing rules for all trips, overnights, etc.
  9. Displays of affection (hugs) show our love and concern and should only be done in public areas with other adults present.
  10. No physical discipline (spanking, shaking) will be tolerated.
  11. An Accident/Injury Report (Form II) is to be completed by the adult supervisor within 24 hours of the incident. Injuries requiring medical treatment (band-aids, cleaning or any other first aid) should be verbally reported to the appropriate staff member within two hours. Injuries requiring EMS notification should be verbally reported immediately. Completed Accident/Injury Report Forms should be filed with the church office and will be kept for five years. The parents or legal guardians should be promptly notified.
  12. The church office will keep forms and policies for employees and volunteers.
  13. Employees and volunteers are required to report any suspicious or inappropriate behavior that suggests (1) sexual abuse or exploitation, (2) neglect, (3) physical abuse, or (4) emotional abuse

III. On-Site Activities

  1. Children must be under the care, guidance, leadership or supervision of an adult at all times. This shall be done by one of three methods:
  2. An adult related by blood, marriage or adoption
  3. An adult deemed to care for the child by the parent or legal guardian of the minor children
  4. Two adults designated to be responsible by the program director.
  5. An adult shall accompany preschool-age children to the restroom and leave the door open.
  6. Off-Site Activities

(when children and employees or volunteers are participating in an OSLC sponsored event)

  1. As each facility will be different, it will be the responsibility of the program director to determine how best to use the facility and comply with church policy.
  2. Overnights: Males and females shall be segregated during the sleep time. If it is necessary for adults to share sleeping accommodations with the children or youth, a minimum of two adults, the same sex as the children or youth being chaperoned shall sleep in each area.
  3. All volunteer and staff persons who drive and/or chaperone off-site trips involving minors shall be in conformance with all aspects of the Safe Sanctuary Policy. Verification of adequate insurance, for all vehicles and their drivers designating a minimum of $100,000 personal liability clause in their vehicle insurance will be kept on file at the church office (Form III).
  4. Written parental permission is required for transporting minors and for minors to attend programs which are scheduled away from the church property (Forms IVA and IVB).
  5. Non-church Sponsored Use of the Church Facility
  6. No outside group will be allowed to provide their own childcare services.
  7. An outside group must contract with OSLC for nursery or childcare for services during its activities (i.e. weddings funerals, dinners, graduations, AA). At the time an outside group contract is made with a non-church group or person to use the church facility, written confirmation must be obtained from the outside group program director certifying compliance with this policy.
  8. Any outside group who uses OSLC facilities (Boy and Girl Scouts, mission groups, music classes, AA, tutoring or choir groups) will be required to comply with the church’s two-adult rule as defined under Procedures and Guidelines II. Supervision (see above).
  9. Personnel Ministries
  10. Each newly hired employee will be given a copy of The Safe Sanctuary Policy.
  11. An obligation to enforce the policy shall be written into the contract of each employee of Our Saviour Lutheran Church.
  12. The Christian Education Ministry committee will review the Safe Sanctuary Policy implementation annually with a subsequent report presented to the OSLC Council of Ministries.



 Definitions of Child Abuse and Neglect According to the state of Tennessee (TN government website. 4/4/2012)

Child abuse and neglect occurs when a child is mistreated, resulting in injury or risk of harm. Abuse can be physical, verbal, emotional or sexual.

Physical Abuse is non-accidental physical trauma or injury inflicted by a parent or caretaker on a child. It also includes a parent’s or a caretaker’s failure to protect a child from another person who perpetrated physical abuse on a child. In its most severe form, physical abuse is likely to cause great bodily harm or death.

Physical Neglect is the failure to provide for a child’s physical survival needs to the extent that there is harm or risk of harm to the child’s health or safety. This may include, but is not limited to abandonment, lack of supervision, life endangering physical hygiene, lack of adequate nutrition that places the child below the normal growth curve, lack of shelter, lack of medical or dental that results in health threatening conditions, and the inability to meet basic clothing needs of a child. In its most severe form, physical neglect may result in great bodily harm or death.

Sexual Abuse includes penetration or external touching of a child’s intimate parts, oral sex with a child, indecent exposure or any other sexual act performed in a child’s presence for sexual gratification, sexual use of a child for prostitution, and the manufacturing of child pornography. Child sexual abuse is also the willful failure of the parent or the child’s caretaker to make a reasonable effort to stop child sexual abuse by another person.

Emotional Abuse includes verbal assaults, ignoring and indifference or constant family conflict. If a child is degraded enough, the child will begin to live up to the image communicated by the abusing parent or caretaker.

  1. Initial Reporting of Suspicious or Inappropriate Activity
  2. Suspicious or inappropriate activity must be reported immediately to the appropriate staff person in charge of the event.
  3. Each person who receives knowledge of the incident must complete and submit the Knowledge of Suspected Incident of Child Abuse (Form IV) to the Child Protection Team (this consists of Christian Education Ministry chairperson, Council president and Pastor).
  4. The Child Protection Team member receiving report Form V shall check the date and time of the incident for accuracy (item 4, Form V) and the statement of the incident (item 5, Form V) for clarity and then sign, date and acknowledge the time of reception of Form V on item 9 of Form V.

III. Responding to the Initial Report of Suspicious or Inappropriate Activity

  1. The Child Protection Team shall determine if they have reasonable suspicion that abuse or neglect to a child may have occurred. If the allegation involves an employee, the chair of Mutual Ministry shall be involved in that determination.
  2. The Child Protection team must comply with all state laws.
  3. All allegations shall be regarded as serious, due consideration shall be given to the rights and privacy of both the alleged victim and the person being accused.
  4. The accused individual, whether staff or volunteer, will be required to refrain from participating in all child activities until it is determined if further action shall be taken. Care shall be taken to respond to all allegations in a professional manner.
  5. Response to Allegations of Abuse or Neglect
  6. If the Child Protection Team determines there is reasonable cause to suspect criminal child abuse or neglect then the following actions shall be taken:
  7. A report will be made to the proper authorities: Department of Children Services: 1-877-237-0004.
  8. All allegations will be taken seriously and will be responded to in a professional manner.
  9. Notify the Bishop of the Southeastern Synod.
  10. If appropriate under the law, under the strict guidance of the church’s legal counsel, insurance carrier and the Bishop of the Southeastern Synod, the Child Protection Team shall:
  11. Contact the alleged victim’s parents, if it will not put the child in jeopardy.
  12. Maintain the documents of all efforts to handle the situation.
  13. After the Child Protection Team has fulfilled its legal reporting requirements, a committee member (preferably a non-staff member) shall be assigned to be the spokesperson. This person will be the sole individual communication to outside authorities or other persons (including the Council, the congregation and the media) regarding the incident.
  14. As this short-term response plan (as listed in a-c) reaches full implementation, the Child Protection Team will meet to review the case and develop a plan for long-term response, as they deem necessary.


  1. All personal information shall be treated in a highly confidential manner, except as required by legal reporting requirements or legal process.
  2. All forms and reference reports shall be kept as part of an applicant’s confidential personnel file. All forms shall be kept in a locked file on the church premises. Files will be destroyed when a volunteer is no longer a member of Our Saviour Lutheran Church or after a five year non-involvement with children/youth programs at OSLC.

III.   Volunteers with will be required to complete a Volunteer Application Form (Form I) and attend the educational training event every three years. In the interim years volunteers will be required to initial, update and date their Volunteer Application Form information annually.

  1. Employees will be required to attend the educational training every three years.

Form I

Our Saviour Lutheran Church

Application Form for Volunteers in Youth Work

This screening form is to completed by all persons, 21 years or older, involved in any way with supervision of, or contact with, children younger than 18. All information on this form will be kept confidential.

Our Saviour Lutheran Church seeks to provide an environment safe from physical and sexual abuse.

  1. Adults who have been convicted or are guilty of either sexual or physical abuse, or sexual exploitation of a minor should not volunteer in any church-sponsored activity or program for children, youth or vulnerable adults.
  2. Adults who have been abused or exploited physically or sexually need the love and acceptance of this church. It is our hope that are previously abused or exploited adults who are considering volunteering to work with children, youth or vulnerable adults have therapeutically resolved any issues in their past that might negatively affect their volunteers service. If these issues are resolved, we offer our commendation. If they are not, we pray they will accept our help by connecting them with a pastor.
  3. All volunteers of Our Saviour Lutheran Church who work with children shall be baptized followers of Jesus Christ and have a commitment to the church.
  4. All volunteers of Our Saviour Lutheran Church who work with children shall know and abide by the OSLC Safe Sanctuary Policy.


Personal Information


Date _____________   Phone Number ________________________


Last name ____________________________


First name__________________ Middle name ___________________

Street address _____________________________________________


City ____________________________________ State _________


Do you have a driver’s license? Yes ____ No ____


Driver’s license number


If no, identity must be confirmed with another approved id:


ID _______________________   ID # ______________________


Do you have physical limitations or medical conditions that might affect your ability to work with infants and children? Yes ___ No ___

If yes, please explain




Have you ever been charged and/or convicted of a crime involving

abuse?   Yes ___ No ___   If yes, please explain (you may write on the back of this form if necessary).










List any gifts, callings, training, education or other factors that have

prepared you for work with children and youth.













Volunteer’s Statement


The information contained in this application is correct to the best of my knowledge. I hereby authorize Our Saviour Lutheran Church to do a criminal records check (upon my completion of an authorization and request for criminal records check).


I agree to be bound by the Constitution, Bylaws and policies of Our Saviour Lutheran Church.


I further state that I have carefully read the statement and know the contents thereof, and I sign this release as my own free act. This is a legally binding agreement which I have read and which I understand.



applicant’s signature     _____________________________________



date     _____________________________________

Form II

Our Saviour Lutheran Church

Accident/Injury Report

Date of accident/injury: __________________________

Time of accident/injury: __________________________

Name of participant injured: ____________________________________


Address of participant injured: _____________________________________________



Location of accident/injury: _____________________________________

Parent, guardian or emergency contact notified: _______________________

Names of person(s) who witnessed the accident:

Name: _________________________________ Phone: ________________

Name: _________________________________ Phone: ________________

Name: _________________________________ Phone: ________________

Describe accident/injury: _________________________________________



First aid treatment: _____________________________________________


EMS contacted? ________________________________________________




signature of person submitting report

Form III

Our Saviour Lutheran Church

Volunteer Driver Application

(valid for one calendar year)


The primary concern when transporting children and youth of Our Saviour Lutheran Church (Johnson City, TN) is their safety. Drivers providing transportation must be properly licensed and insured, and their vehicle must be properly registered and maintained.

When transporting children and youth, the following safety standards

must be met:

  1. A fixed seat belt is used by the driver and each passenger. No doubling up in seat belts. Use of infant car seats and booster seats shall be in compliance with state law, which requires that infants under one year of age and weighing less than 20 pounds ride in a rear-facing car seat. If the car seat has a rear-facing weight limit over 20 pounds, the infant may remain rear-facing beyond one year and 20 pounds. Children under age 4 must ride in a car seat. Tennessee requires that all car seats be federally approved and used according to manufacturer’s instructions. Children over age 4 but under age 8 and less than 5 feet in height must use a booster seat. Children over age 8 but less than 5 feet in height must use a vehicle seatbelt. Children through age 12 who are greater than 5 feet tall are required to use a vehicle seatbelt, and the rear seat is recommended for these children. Tennessee requires that all children under age 16 who are not in a car seat or booster use a vehicle seat belt.
  2. The driver is currently licensed and carries at least the minimum insurance required by the state of Tennessee.

NOTE: minimum requirements may not be adequate under all circumstances; consult your insurance company to be sure that your coverage is sufficient for youth group activities.

  1. The driver is an adult (21 years or older) with broad driving experience, mature judgment and a safe driving record.
  2. If needed, there is adequate space for luggage and equipment, which is stowed securely.
  3. The vehicle is serviced regularly and is in safe operating condition.

Form IVA

Our Saviour Lutheran Church

Parent Consent and Medical Authorization Form

(valid for one calendar year only)

year ________________

Parents and legal guardians of minor children are asked to complete this form and return it to Our Saviour Lutheran Church.

The information requested is designed to assist the church in providing for the safety of minors during church-sponsored activities.
General information:


Child’s name ______________________ Date of birth ____________


Father’s name __________________________________


Mother’s name __________________________________


Guardian’s Name __________________________________


Child’s address __________________________________


Home phone number __________________________________


Father work phone___________________cell phone _____________


Mother work phone __________________cell phone _____________


Other emergency contact _______________________________


Phone number _________________ Relationship to child ___________


Consent and certification

I, the undersigned being the parent or legal guardian of the child named above (“the child”), do hereby consent to the participation of my child in the activities, which may include retreats, trips out of Johnson City, pool parties, skating and other activities which may be associated with youth groups at Our Saviour Lutheran Church of Johnson City, TN.

I do NOT authorize my child to participate in any of the following

activities (please list):






Is your child presently being treated for an injury or sickness or

taking any form of medication for any reason?   Yes___ No ___

If yes, please explain:





Is your child allergic to any type of medication or food? Yes___ No ___

If yes, please explain:







Does your child require a special diet? Yes___ No ___

If yes, please explain:





Does your child have (or ever had) any of the following (check and explain below?


seizure disorder___   asthma ___   heart murmur ___

diabetes ___   hay fever ___   kidney disease ___


Please explain:





Does your child have any handicap or illness that would present him or her from participating in normal rigorous activity ?   Yes___ No ___


Please explain:





Does your child ever sleep walk ?   Yes___ No ___


Can your child swim ?   Yes___ No ___





Physician’s Name ________________________________________


                 Address  ________________________________________


                     Phone  ________________________________________



Name of insurance company __________________________________

Address __________________________________________________

ID number _______________________________________________

No insurance at this time ____________________________________


Medical treatment authorization


I undersfand that I, my child’s other parent/guardian or the emergency contact named above, will be notified in case of a medical emergency involving my child. However, in the event that I, my child’s other parent/guardian or the emergency contact named above cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. I understand that neither Our Saviour Lutheran Church nor the adult presenting my child for medical treatment will be responsible for medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

I agree to notify our Saviour Lutheran Church in the event of any health changes which would restrict my child’s participation in any normal youth or children’s activities. I also understand that the adult supervisors reserve the right to restrict my child from any activities that they do not believe are within the physical capabilities of my child.



signature of parent/ guardian   _______________________________


date     _______________________________



Form IVB

Our Saviour Lutheran Church

Parent Permission Form

(valid only for the activity named below)


I give my permission for my child, ______________________________, to participate in (activity) ________________________________________ on (date) _____________________________

at (place) ___________________________________________________.


I understand that my child will be transported to this activity by (mode of transportation) ________________________________________________.


I have completed an accurate Parental Consent and Medical Authorization Form on file with Our Saviour Lutheran Church.



signature or parent/guardian




Form V

Our Saviour Lutheran Church

Knowledge of Suspected Incident of Child Abuse

  1. Name of worker (paid or volunteer) observing, receiving disclosure or any information of suspected abuse of a minor:


  1. Minor’s name: _____________________________________________

Minor’s age/ date of birth: ____________________________________

  1. Informant’s name (if applicable): ________________________________
  2. Date/ Place of initial conversation with/ report from minor or informant:




  1. Minor’s or informant’s statement (give detailed summary here):





  1. Does minor appear to be injured? No______ Yes_____


  1. Name of person accused of abuse: _______________________________

Relationship of accused to minor (staff, volunteer, family member, other):



  1. Report to Child Protection Team: ____________________________


Time: _________________


__________________________________________     ______________

signature of person submitting report                                date



  1. Name of Child Protection Team member receiving report and Form IV:





Time: _________________




__________________________________________     ______________

signature of Child Protection Team member                      date