THE SAFE CONGREGATION HANDBOOK

For the First Unitarian Church of Philadelphia

Table of Contents

I. Preamble (p.2)
II. Common Cases (p.3)
III. Definitions (p.4)
IV. Prevention (pp. 5-8)
A. Duties of a Safe Congregation Ministry Team
B. Screening and Selection of Workers with Children and Youth
C. Supervision Procedures
D. Conduct for Adults Working with Children and Youth
i. Code of Ethics
E. Education and Implementation
V. Response (pp. 8-12)
A. Duties of a Sexual Misconduct and Abuse Response Team
B. Reporting Procedures
C. Responding to Allegations of Abuse or Misconduct by an Adult
D. Responding to Cases in which the Abuser is a Youth or Child
VI. Restoration (pp.12-17)
A. Assessment and Conditions for Inclusion of an Adult Offender
B. Draft Limited Access Agreements
i. Standard Format
ii. Checklist Format
VII. Appendices (pp. 18-22)
A. Driver Qualification for Transporting Minors
B. Background Investigation and Authorization Form
C. Field Trip Permission and Consent for Medical Treatment Form
D. Overnight Medical Information Form

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 The First Unitarian Church of Philadelphia
A CERTIFIED SAFE CO NGREG ATION

I. PREAMBLE

We, the members of the First Unitarian Church of Philadelphia, recognize, with sadness, the reality that
our children and young people are vulnerable to the outrage of physical, sexual, and emotional abuse. As
a community dedicated to preserving the inherent worth and dignity of every person, we covenant to
affirm ways to prevent physical, sexual and emotional abuse, to immediately respond to abuse with
professional integrity, as well as to engage in restorative practices with the intent to affirm justice, equity
and compassion in all our relations.

1. Prevention
In support of the principals of the Unitarian Universalist Association, we believe:
• Every person is sacred and worthy of respect; therefore they should not be violated, physically,
sexually or emotionally.
• Accepting each other as we are means doing no harm and fostering well-being in ourselves as
well as others.
• As a community and a religious organization, we are responsible for creating a secure, safe,
and non-violent environment.
Therefore, be it resolved, the First Church family will do everything in its power to prevent
abuse by creating a safe and nurturing environment with efficient and well-publicized
procedures.

2. Response
We know that religious communities are not immune to the dangers of sexual abuse. We
acknowledge that when abuse occurs, it is a tragedy, not only for the abused, but also for their
families, our congregation and our wider community as well. Therefore, be it resolved that if an
abuse occurs, we will do everything in our power to respond in a speedy, professional and caring
manner that will preserve everyone’s dignity.

3. Restoration
We also know that religious communities are often unaware of being host to adult sex offenders.
Research shows that congregations that ignore this fact, and who create a culture of secrecy,
increase the likelihood of abuse. Therefore, the First Church family is dedicated to collaborating
with governmental and private agencies to help reintegrate offenders who have proven records of
rehabilitation. The First Church reserves the right to determine the conditions for the offender’s
inclusion in community, as articulated in a Limited Access Agreement. Under no circumstances
will such an agreement compromise the congregation’s commitment to prevent abuse. However,
we are aware that if such a process is not created then offenders are less likely to be open and
truthful with other congregations, thereby perpetuating a culture of secrecy. Therefore, the First
Church family is committed to create a restorative process based on truth and reconciliation. We
expect offenders to speak truthfully about their past and to work toward reconciliation with all
who were harmed by their previous offenses. In doing so, we engage in restorative ministry by
sharing in the responsibility for creating a safe, open and healing community for everyone.

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In this spirit we developed the following Child and Youth Protection Policies and Procedures that will
influence all sponsored activities and events, thereby certifying the First Unitarian Church of
Philadelphia as an official “Safe Congregation.”

II. COMMON CASES

The Reverend Debra W. Haffner, Executive Director of the Religious Institute on Sexual Morality
Justice and Healing, explains that all of the following situations involving sex offenders – and
undoubtedly others – have occurred in Unitarian Universalist congregations. As a result, the following
document is designed to address any of the following scenarios.

• A person who is a known sex offender is invited by one of the lay leaders of the congregation to
join the faith community.
• During a pastoral care session, a man reveals to the minister that he feels like he is "on fire around
children".
• A twelve-year-old (who attends religious education) from the congregation is babysitting for a
four-year-old boy, who later that evening, tells his parents that the babysitter asked him to touch
his penis.
• A person who used to be a member of the congregation writes the minister (who has never met
him) to say that he is about to be released from jail for a sex offense and wants to return to the
congregation.
• A convicted sex offender decides that the restricted access agreement he has been asked to sign is
too restrictive at one congregation and begins to attend another one in the area.
• A newly settled minister of one month discovers that a person in the community was arrested for
child molestation over fifteen years ago; when the previous minister departed, he never told
anyone.
• A long standing member of the congregation is charged with uploading child pornography on an
Internet bulletin board.

Haffner explains that “In each case, the minister, the board of trustees, and key lay leaders didn't know
what to do. One minister reports that ‘this was the most difficult decision I have faced in fifteen years in
ministry.’ These situations can exacerbate people's most painful personal histories, and congregations
often experience divisive conflicts over how to handle such situations.” Therefore, as a responsible
community dedicated to prevent and respond to sexual abuse as well as engage in restorative practices,
we thereby establish the following policies and procedures.

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III. DEFINITIONS

“Abuse” is an act committed by a parent, caregiver, or person in a position of trust that harms or
threatens to harm a child or youth. There are four categories of abuse: physical, sexual, emotional or
mental, and neglect. Harm caused by withholding life’s necessities – food, clothing, shelter, medical
care, education – is called “neglect”.

A “child” or “minor” is a person under the age of 18 years. “Youth” means people between 14-17 years,
inclusive.

A “Group” is defined as those children or youth under the age of 18 who have been assigned to a
nursery, preschool, Religious Education (RE) class or are participating in any planned, organized
program or activity.

“Mandatory Reporters” are persons who are under a legal duty to report abuse to designated civil
authorities. Pennsylvania law makes no distinction between paid staff and non-paid volunteers.
Accordingly, volunteers who come into contact with children in the course of their church duties are
mandatory reporters. Mandatory reporters must report reasonably suspected cases of child abuse to the
Department of Public Welfare (DPW) whenever there is “reasonable cause” to believe that a child may
have been abused. Any person who has reasonable cause to suspect child abuse is permitted by law to
make a report.

“Sexual Misconduct” is the wrongful, improper or unlawful actions motivated by premeditated or

intentional purposes or by obstinate indifference to the consequences of one’s sexual acts.

The “Sexual Misconduct and Abuse Response Team”, also known as the “Response Team”, is the
authorized body responsible for all First Unitarian Church of Philadelphia formal responses to
allegations / reports of abuse as outlined in this policy.

The “Safe Congregation Ministry Team” is the established body within First Unitarian Church of
Philadelphia that is entrusted with the implementation of this policy.

A “supervisor” is an adult charged with maintaining the safety of his or her assigned group through the
reasonable exercise of thoughtful action and responsibility. What constitutes appropriate supervision
will vary with the ages of those in the group and the context of the activity.

“Workers” are persons, including teens, who are engaged with a group of children or youth at First
Unitarian Church of Philadelphia, whether they are paid or unpaid, permanently assigned or occasional.

The “DRE” or “CRE Director” refers to the Director of Children’s Religious Education.

A “Church Member” is an official member of the congregation as defined in the church bylaws.

A “Church Friend” is a registered participant and financial contributor of the church as a non-member as
defined in the church bylaws.

A “Religious Professional” is a trained staff member hired to perform religious functions, such as the
Minister, Director of Religious Education or the Music Director.

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IV. PREVENTION

IV. (A) DUTIES OF THE SAFE CONGREGATION MINISTRY TEAM

The Safe Congregation Ministry Team will:

1. Consist of the Minister, the Director of Religious Education, the Young Adult Ministry
Coordinator and at least two other members of the congregation.
2. Designate members of the team to serve as liaisons to the Children, Youth and Young Adult
ministries.
3. Attend an annual orientation and training in safe congregation issues.
4. Review policies, procedures and pertinent legal changes, and make recommendations to the
Board.
5. Work with the Caring Ministry Team to research and publish a referral list of caring
professionals.
6. Educate the congregation about the safe congregation policies and procedures on an ongoing
basis.
7. Provide resources to congregants relating to sexual abuse, ethics and procedures.
8. At least once a year, report to the Board and Congregation the work of the Safe Congregation
Ministry Team.

IV. (B) SCREENING AND SELECTION OF WORKERS WITH CHILDREN AND YOUTH

Those volunteers who provide direct care or supervision for children or youth at First Unitarian Church
of Philadelphia must meet the following criteria:

1. Each volunteer worker must be:

a. An active participant at First Unitarian Church of Philadelphia, as a church member or
friend for at least six months prior to taking on any assigned group, committee, activity or
event OR:
b. An active participant as a church member or friend in good standing at another Unitarian
Universalist (UU) congregation for at least one year duration through the current or
preceding calendar year. Exceptions can be made at the discretion of the Director of
Religious Education (DRE) with provision of appropriate references.
c. Over the age of 18, unless approved by the DRE.
2. Youth or children who teach and/or assist in church school and childcare must work with an
adult.
3. Applicants with a documented history of abuse or admitted sexual misconduct are prohibited
from providing direct care or supervision of children or youth below the age of 18 years.
4. All workers must complete the application forms included in this policy and must consent to
such reference and background screening as First Unitarian Church of Philadelphia deems
necessary, and must agree to be bound by the Code of Conduct set forth in this policy.

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 5. All workers are required to read and agree to the terms set forth in this Handbook prior to
beginning their duties with any group or program involving direct care or supervision of children
or youth at First Unitarian Church of Philadelphia.
6. Parents are permitted and encouraged to visit their child’s class at any time.

IV. (C) SUPERVISION PROCEDURES

All workers are subject to the supervision and evaluation of the DRE. All workers are required to
comply with the following policies to ensure a safe and secure environment for our children and youth:

1. Each group should have at least two workers present at all times with at least one worker being
an adult. For infants and toddlers, the desirable ratio is one worker for each three children. The
Minister or DRE shall determine the appropriate level of supervision for each group and activity,
and may make exceptions to this rule on a case-by-case basis.
2. In order to provide visibility into classrooms any window coverings will be open and/or the door
to any classroom must remain open at all times.
3. The DRE and/or designee shall circulate the RE classroom area and monitor classroom activities
randomly during regular RE classes.
4. When taking children to the restroom, the worker should stay out of the restroom until the child
is finished. Children need as much privacy as possible when using bathroom facilities and
workers are to enter and assist only when necessary.
5. All outings must be pre-approved by the DRE. Participating children must have a signed
permission slip from a parent or guardian.
6. Children third grade and younger must be picked up by a parent or guardian unless prior
arrangements have been made with the DRE or Teacher.
7. Corporal punishment or abusive language may not be used under any circumstances. This
includes behavior that constitutes verbal, emotional, or physical abuse and behavior or language
that is threatening or demeaning.
8. Behavior must both be and appear to be exemplary.

IV. (D) CONDUCT FOR ADULTS WORKING WITH CHILDREN AND YOUTH

1. First Unitarian Church of Philadelphia seeks to create an environment in which children and
youth can explore the spiritual and religious nature of their lives. We actively encourage
relationships between young people and adults, and know that when healthy and genuine they
can be transformative for both the adult and the child involved.
2. Workers are expected to nurture the child’s physical, emotional and spiritual growth by treating
him/her with kindness, trust, respect and good humor. Interactions must be genuine and not
manipulative of the child’s needs or vulnerabilities. They must always be engaged with the best
interests of the child as the foremost goal.
3. We expect all adults and youth working with children to understand the power differential in
child/adult relationships. This differential places greater responsibility on the adult in the

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 relationship. No matter the age of the child, it is always the responsibility of the adult to
maintain appropriate boundaries in order to promote an atmosphere of health and trust. To that
end we ask all workers to endorse the following Code of Ethics:

Code of Ethics for Adults and Older Youth

Who Are Engaged In Leadership Roles with Children/Youth
“Adults and older youth in leadership roles are in a position of responsibility and mentorship,
and play a key role in fostering the spiritual development of individuals and the community. It is,
therefore, especially important that those in leadership positions be well qualified to provide the
special nurture, care, and support that will enable children and youth to develop a positive sense
of self and a spirit of independence and responsibility. The relationship between young people
and their leaders must be one of mutual respect if the positive potential of their relationship is to
be realized. There are no more important areas of growth than those of self-worth and the
development of a healthy identity as a sexual being. Adults play a key role in assisting children
and youth in these areas of growth. Wisdom dictates that children, youth, and adults suffer
damaging effects when leaders become sexually involved with young persons in their care;
therefore, leaders will refrain from engaging in sexual, seductive, or erotic behavior with
children and youth. Neither shall they sexually harass or engage in behavior with children and
youth which constitute verbal, emotional, or physical abuse. Leaders shall be informed of this
code of ethics and agree to it before assuming their role. In cases of violating of this code,
appropriate action will be taken. “ Adopted by the Unitarian Universalist Association in 1986.

4. Other areas that may be of concern:

a. Physical Affection: Physical expressions of affection such as hugs are acceptable, but it
is best to allow the child to initiate the contact or to at least to ask permission of the child,
and the adult must be sensitive not to allow such affection to become too frequent or
prolonged.
b. Tobacco, Drugs and Alcohol: The use of tobacco, alcohol or drugs by minors is
prohibited. Workers should at all times be aware that their own behavior is a powerful
statement to children as to what is acceptable and responsible use of these agents. Adults
while acting in a supervisory capacity should not use alcohol or drugs and should use
tobacco, if at all, moderately and discreetly.
c. Confidentiality vs. Secrets: If a child discloses incidents of abuse or neglect, the worker
should listen carefully to the report but ask limited non-leading questions, only to
determine what action to take. The worker should document any and all conversations as
soon as possible. Should the disclosure raise a suspicion that abuse has occurred or that
the child is in imminent danger, the worker should report immediately to the Department
of Public Welfare (DPW) and the Response Team. While you can assure a child that you
will respect the information and use it confidentially, never give the child the impression
that you will keep secrets. Secrets are issues that put a person in danger.
d. Disclosures: Children’s statements will be taken seriously. In the event that a child
makes a disclosure, or in an emergency situation, an approved adult will stay with the
child until Children, Youth and Family services and/or the Response Team has been
contacted.

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IV. (E) EDUCATION AND IMPLEMENTATION

All church leaders share in the responsibility for educating the congregation about the Safe
Congregation Handbook. All church members and friends share in the responsibilities of all the
procedures within the handbook. In summary, they are as follows:

1. A copy of the Handbook will be provided to anyone identified by the DRE as being within its
definition of “worker”. All new and existing workers will be required to sign a form indicating
that they have read the Handbook and agree to be bound by it.
2. The Handbook will be distributed to the parents of all children currently participating in the RE
program, and thereafter a copy shall be provided to the parents of children enrolling for the first
time.
3. References to the Handbook will be a standard part of every application interview and training of
new workers.
4. Teacher training on the Handbook and on child abuse awareness and prevention will be
conducted annually.
5. At least once each year, the DRE or a designee will compare a current list of approved workers
with sexual abuse registry lists generated by municipal, county and/or state units of government.
6. The DRE shall store all application forms, signed consents and background check reports in a
locked file.
7. The Safe Congregation Ministry Team will report annually to the Board of Trustees or the
Executive Team regarding the implementation and compliance of this policy.
8. The Safe Congregation Ministry Team shall publish and make available a brochure summarizing
this policy.
9. Anyone with access to volunteer disclosures, background check reports and application forms
must agree to hold that information in confidentiality except to share relevant information with
the Response Team members.

V. RESPONSE

V. (A) THE SEXUAL MISCONDUCT AND ABUSE RESPONSE TEAM (RESPONSE TEAM)
SHALL:

1. Consist of the Minister, the Director of Religious Education and one appointee of the Board and
at least one alternate.
2. Be members of the Safe Congregation Ministry Team.
3. Screen all applications for paid staff positions and all CRE teachers and volunteers. Screening
may be performed by a Response Team member or a designee, with the results reported to the
Response Team in confidence.
4. Investigate incidents of abuse involving church members at all church sponsored functions as
well as incidents involving members that did not occur on church grounds. Report allegations as
required by Pennsylvania law. Decide if it is appropriate, and to what extent, to permit access to

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 the church by an alleged, admitted or convicted abuser. Negotiate a Limited Access Agreement
with that person and propose it to the Board for approval.

V. (B) REPORTING PROCEDURES

Pennsylvania law makes no distinction between paid staff and non-paid volunteers. Accordingly,
volunteers who come into contact with children in the course of their church duties are mandatory
reporters. Mandatory reporters must report reasonably suspected cases of child abuse to the Department
of Public Welfare (DPW) whenever there is “reasonable cause” to believe that a child may have been
abused. Any person who has reasonable cause to suspect child abuse is permitted by law to make a
report. In addition, anyone who suspects any child abuse should notify the Response Team (comprising
of the Director of Religious Education, the Minister, and a member of the congregation appointed by the
board).

The Response Team will notify the following as applicable:

1. Philadelphia County Authorities (DHS):
a. Call the Philadelphia Department of Human Services child abuse hotline immediately at
215-683-6100.
b. If no one is available at that number, call the Pennsylvania Child Hotline at 1-800-932-
0313.
c. Within 48 hours, file a written report (form CY-47). This form should include the
following information as required by statute:
i. Names/addresses of child and parents or other person responsible for care of
child, if known.
ii. Where suspected abuse occurred.
iii. Age and gender of the child.
iv. Nature and extent of suspected abuse, including any evidence of prior abuse to
child or child’s siblings.
v. Name and relationship of person(s) responsible for causing abuse, if known, and
any evidence of prior abuse by that person(s).
vi. Family composition.
vii. Source of the report.
viii. Person making the report and contact information.
ix. Actions taken by reporting source.
2. A parent or guardian
3. First Unitarian Church of Philadelphia Lawyer
4. President, First Unitarian Church of Philadelphia Board of Trustees
5. Insurance Company
6. Media Spokesperson designated by the Board

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The Response Team should document all notifications, including telephone calls to the hotline, and
retain this documentation in the Church records along with all written reports. An approved adult should
stay with a child in any emergency situation that involves disclosure of abuse. Pastoral care and
counseling referrals should be provided as desired.

V. (C) RESPONDING TO INCIDENTS OR ALLEGATIONS OF ABUSE OR MISCONDUCT BY

AN ADULT

1. Meet directly with those involved. Once a situation arises, as quickly as possible, the
Minister (with a Response Team member) should meet privately with:
• The alleged or convicted abuser, and possibly his or her partner or family, to discuss
the concerns that have been raised.
• The alleged victim’s parents or guardians if the child or youth is also in the
congregation, to discuss what is known and what steps will be taken.

a. In the case of a known adult sex offender: If an adult has been successfully prosecuted
for a sexual offense and is entering or returning to the congregation, before meeting with
that individual, the Minister and members of the Response Team should:
i. Check the local sex offender registry for further information.
ii. Speak with the probation or parole officer with written permission from the
individual.
iii. Obtain authorization to conduct a criminal or sexual abuse background check.
b. In the case of an alleged abuse: If there is an allegation of sexual abuse naming an adult
in the congregation, before meeting with that individual, the Minister or member of the
Response Team should:
i. Find out the details of the allegation.
ii. Find out what actions have been taken. For example, the Response Team member
may want to inquire if the allegation has been reported to the appropriate
authorities, if there is a current investigation, and if there are other allegations
against this individual.
iii. Obtain authorization to conduct a criminal or sexual abuse background check.
c. In the case of an adult seeking help: If an adult talks about his/her attraction to
children, but has not acted on that attraction, before meeting with that individual, the
Response Team member in consultation with the Response Team will have:
i. Educated him/herself about the effectiveness of treatment.
ii. Found referrals to a professional who has the expertise to work with someone at
risk of sexually abusing a child.
d. In the case of a known youth/child who may have abused: If there is an allegation of
sexual abuse naming a teen or child in the congregation, the process will be very different
than the process for dealing with an adult. Before meeting with that child or teen, the
Minister and members of the Response Team should review the process for taking steps

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 when youth have abused. (See “Guidelines for Dealing with Cases in which the Abuser is
a Youth or Child.”)
e. In the case of an allegation of a religious professional as an abuser: If there is an
allegation of sexual abuse naming a religious professional of the congregation:
i. These steps do not apply.
ii. The President of the Board should be contacted immediately.
iii. The President should contact the Director for Congregational Services at the UUA
and/or the District Executive serving the congregation.
2. Convene the Response Team. After meeting with the individual, if the Minister determines that
there is genuine cause for concern, the person should then be asked to meet with the Minister and
the Sexual Misconduct and Abuse Response Team. The adult in question should be told that the
purpose of meeting with the Team is to:
i. Ensure the safety of everyone involved
ii. Determine if it is possible to be involved in congregational activities
iii. Set the next steps into place
iv. At this point, it may be helpful to contact the congregation’s attorney to inform
him or her of the situation.
All meetings and conversations should be briefly documented and accounted for in a record by
the Minister or the Team. Be sure to keep the documentation in a secure location and not
accessible to anyone who enters the office.

V. (D) RESPONDING TO INCIDENTS OR ALLEGATIONS OF ABUSE OR MISCONDUCT BY A

YOUTH OR CHILD

One of the most difficult possible situations is when a teenager or child in the congregation has been
accused of abusing or mistreating a child, either sexually or non-sexually, in the congregation. The
difficulty is that in some cases these children may simply be acting on their feelings impulsively, not
quite understanding the importance of boundaries, whereas in other cases, youth and children who
abuse, bully or engage in sexual activity with other children (or even adults) may become future adult
offenders. In any of these cases, pastoral care and support for the families involved is crucial. This will
be very difficult for the parents involved, and they will need the support of their church community,
especially the minister and the DRE. Helping them to feel welcome and supported is essential, as is the
ongoing offer of ministry.

1. After an incident comes to the attention of the Minister or other staff member, the Minister
should initiate contact individually with the parents of both children to discuss the allegation and
next steps. The Minister should then decide if the incident warrants the involvement of the
Response Team.
2. The Minister should encourage the parents of the child who was mistreated to seek an evaluation
for this child. Contact the Association for the Treatment of Sexual Abusers (ATSA) or the Safer
Society Foundation for referrals if you don't have a local list of therapists with expertise in this
area.

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 3. The parents of the child who initiated the mistreatment or abuse need to be engaged more
thoroughly in discussions about next steps. It may be necessary to call Child Protective Services.
Regardless, before the initiator is allowed to continue to attend religious education, this child
should receive an extensive assessment by a child psychologist or psychiatrist having experience
with childhood sexual or non-sexual behavior problems. The parents should also agree to closely
monitor their child whenever he or she is at the church. It is NOT the responsibility of the
Minister or the Response Team to decide if abuse has occurred, but rather to assure that such
assessment does take place. It may be necessary for the church to pay for such an assessment if
the parent or caregiver cannot afford it.
4. If the evaluation finds that this was simply a case of inappropriate boundaries or impulsive
behavior, and with the recommendation of the therapist that the child can safely attend church
functions with other children, the Minister and the parents can meet with the child to discuss the
importance of never repeating the behavior, the harm it can do to other children, and the
consequences should such a situation occur again.
5. If the treatment provider reports that the child has a more severe behavior problem that is likely
to be repetitive, the Response Team and the parents need to meet to decide how and if the child
can safely be involved with the Religious Education or Youth Group program. A modified
Limited Access Agreement should be developed and signed by both the child and the parents. In
some cases, it may be necessary to deny the young person continued involvement with other
children until treatment is completed and to consider alternative ways to provide religious
education.
6. In some situations, a family will want to bring a child who has been treated for abuse related
offenses back into the congregation after treatment is completed. In such cases, the steps for
involving an adult offender can be followed, including a Limited Access Agreement signed by
both the youth and their parents.

VI. RESTORATION

VI. (A) ASSESSMENT AND CONDITIONS FOR INCLUSION OF AN OFFENDER

1. Bring in Professional Expertise. If the adult has completed a prison sentence and/or a
treatment program, the Response Team should ask that person to sign a release form, allowing
the Team to contact the sex offender treatment provider, probation officer, and/or current
therapist. If the adult has not completed a treatment program or if the adult has come forward
for help, the Response Team should ask the person to go for a professional assessment with a
therapist who specializes in working with sex offenders.
2. Respond to a Lack of Cooperation. If the adult offender refuses permission to contact the
therapist or refuses to go for an assessment, the Minister would be right to refuse that person
participation in any congregational activity. However, if the offender cannot afford a one-time
assessment, the congregation may choose to provide partial or total funding.
3. Ensure Safety First. If the treatment provider indicates that the person has:
a. Successfully completed or is participating successfully in treatment and is not at high risk
to abuse again OR

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 b. The initial assessment of the adult at risk to abuse indicates he or she is low risk to repeat
any abuse.
c. Then the Response Team may choose to move forward with inclusion and develop a
Limited Access Agreement. If the professional assessment indicates that the person is at
high risk for re-offending, it is appropriate to deny that person involvement in the faith
community until treatment is successful at reducing the risk.
4. Determine Conditions for Inclusion. If the Response Team decides to include the offender,
they should meet with that adult and his/her spouse, family or support people to review the
conditions of his/her participation in the community. For example, someone with a history of
sexually abusing children should not be allowed any access to children or youth activities and
should always be accompanied by a "support person" when children or teenagers are present at
intergenerational activities, including worship. These conditions will be listed in their Limited
Access Agreement and Check List Form. All persons with past histories of sexual offenses
should then be asked to sign a Limited Access Agreement or Check List. Upon entry into the
congregation and depending on the circumstances, the person may be asked to review this
agreement quarterly or at least annually with the Team and sign a new one each year.
5. Deny Access if the Adult Refuses to Sign the Limited Access Agreement. If the offender
refuses to sign the Limited Access Agreement, it is then appropriate to deny the person access to
congregation functions and church property.
a. An offender who refuses to sign a Limited Access Agreement should know that if they
enter the congregation or its property, a member of the Response Team or the Board of
Trustees will ask the offender to leave.
b. If the offender further refuses, a Team member should call the local police for assistance.
6. Decide Who Needs to Know. Once the adult signs the Limited Access Agreement, the decision
needs to be made about who in the congregation needs to know a congregant has a history of sex
offending behaviors. Clearly, key people, including the Minister, the DRE, the President of the
Board, and the Response Team need to know that the person:
a. Is attending church;
b. Has agreed not to have contact with children and youth.
c. Has signed a Limited Access Agreement or check list; and
d. Should never be alone with children and youth.
7. Become Part of the Adult’s Circle of Support and Accountability. The Response Team
should decide how often to meet (e.g., at least quarterly) with any individual with whom it has a
Limited Access Agreement to review the arrangement and address any concerns. If the Minister
or the DRE changes, and when the President of the Board of Trustees changes, it is important
that the departing person inform the new person of any existing agreements to ensure provision
of pastoral support for the offender as well as continuity of awareness of the situation.
a. In sharing information appropriately, it is also important to remain aware of
confidentiality and privacy for all involved. Copies of files, including Limited Access
Agreement information, should be treated with care and kept in a secure file drawer. If
and when legal questions arise, the Minister and/or Board President should contact a
lawyer who can provide information and advice and who knows about applicable local
and state statutes.

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 8. Move Toward Healing in the Congregation. Aware that at any step, emotions will surface for
many people, the congregation is dedicated to create a culture of deep caring so as to help
everyone to experience authentic healing. It does so by:
a. Creating caring-ministry teams for victim of sexual abuse to find the pastoral support and
referral system they need to process their experiences;
b. Strengthening the education programs throughout the congregation and informing
members and friends of the Safe Congregation policies and procedures;
c. Regularly reviewing the policies and procedures and updating them as necessary.

VI. (B) DRAFT LIMITED ACCESS AGREEMENTS

Option 1: Standard Format

Introductory Paragraph in cases of allegation:

A serious complaint or allegation, now under review, has been made about you to the Sexual
Misconduct and Abuse Response Team. While this complaint is being investigated, in order to protect
the children and youth in our programs from potential risk, and in order to protect you from further
suspicion, we ask you to abide by this interim agreement. Signing this document in no way constitutes a
presumption or confession of guilt. This is a routine safety precaution, activated without prejudice
toward particular individuals or circumstances. This document will be made known only to the Minister,
the DRE and the members of the Response Team. It will be kept in a locked file in the office.

Introductory paragraph in cases of convicted sex offender:

The First Unitarian Church of Philadelphia affirms the dignity and worth of all persons. We are
committed to being a religious community open to those who are in need of worshipping with us,
especially in times of serious personal troubles. However, based on your background, we have concerns
about your contact with children and youth in our congregation. The following guidelines are designed
to reduce the risk to both you and them of an incident or accusation. We welcome you to our
congregation and our membership but your participation will be limited to ensure the safety of our
children and youth and to assure that you will not be subject to future accusations.

Body of letter, for use in all cases:

Within these guidelines, the congregation welcomes your participation in adult worship services, coffee
hour, committee meetings, adult education, all adult social events, and well supervised intergenerational
events. You are to avoid all contact with children on congregation property or congregation-sponsored
events. This includes the following:

1. Please do not talk with children.

2. Please do not volunteer or agree to lead, chaperone or participate in events for children and youth
including such things as religious education classes, stories or talks for worship, youth group
events, activities during intergenerational events, driving or otherwise transporting children
and/or youth.

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 3. Please remain in the presence of an adult who knows your situation at all times when children
are present.
4. If a child in the congregation approaches you, either at church or in a community place, politely
and immediately excuse yourself from the situation.
5. Please avoid being in the building unsupervised when activities involving children are in session,
such as nursery school or youth group.

I accept that the following people will be told of my circumstances in order for them to protect the
children/youth for whom they care: INSERT NAMES AND/OR POSITIONS WITHIN THE
CONGREGATION

I have reviewed this covenant and agree to abide by its provisions. I understand and agree that if I
violate this agreement, I will be denied access to future church functions and church property.

I understand that this contract will be reviewed regularly every six months and will remain for an
indefinite period.

_______________________________ ___________
Signature Date
_______________________________ ___________
Witness Date
_______________________________ ___________
Minister Date
_______________________________ ___________
Director of Religious Education Date
_______________________________ ___________
Board President Date

Option 2: Check List Format

Introductory Paragraph in cases of allegation:

A serious complaint or allegation, now under review, has been made about you to the Sexual
Misconduct and Abuse Response Team. While this complaint is being investigated, in order to protect
the children and youth in our programs from potential risk, and in order to protect you from further
suspicion, we ask you to abide by this interim agreement. Signing this document in no way constitutes a
presumption or confession of guilt. This is a routine safety precaution, activated without prejudice
toward particular individuals or circumstances. This document will be made known only to the Minister,
the Religious Educator and the members of the Sexual Misconduct and Abuse Response Team. It will be
kept in a locked file in the office.

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Introductory Paragraph in cases of convicted sex offender:

The First Unitarian Church of Philadelphia affirms the dignity and worth of all persons. We are
committed to being a religious community open to those who choose to worship with us, especially in
times of serious personal troubles. However, based on your background, we have concerns about your
contact with children and youth in our congregation. The following guidelines are designed to reduce the
risk to both you and them of an incident or accusation. We welcome you to our congregation and our
membership but your participation will be limited in ways to ensure the safety of our children and to
assure that you will not be subject to future accusations.

Body of letter, to be used in all cases:

You understand that you will not be allowed to volunteer or chaperone events for children and
adolescents, including children's religious education classes, talks with children/adolescents during
worship, youth group, children's and adolescents' activities during intergenerational events, and driving
children and young people.

The following activities checked "Yes" are activities that we feel are appropriate for your participation.

• Worship services No ( ) Yes ( ) With support person* No ( ) Yes ( )

• Coffee Hour: No ( ) Yes ( ) With support person* No ( ) Yes ( )
• Adult meetings with children in building, such as choir: No ( ) Yes ( )
• Adult meetings without children in building: No ( ) Yes ( )
• Have a key to the building: No ( ) Yes ( )
• Intergenerational church activities No ( ) Yes ( ) With support person* No ( ) Yes ( )
• Intergenerational group outings such as ice skating, baseball games, etc: No ( ) Yes ( ) With
support person* No ( ) Yes ( )
• Alone in building with minister or other staff: No ( ) Yes ( )
• Access to church computer: No ( ) Yes ( )
• Social activities in other member's homes with children present: No ( ) Yes ( ) With support
person* No ( ) Yes ( )

Other:

__________________________________________: No ( ) Yes ( )

__________________________________________: No ( ) Yes ( )

__________________________________________: No ( ) Yes ( )

*A support person is a person who knows about your history/situation and has been designated by you
with our approval to accompany you to activities where children and youth may be present.

I accept that the following people will be told of my circumstances in order for them to protect the
children/young people for whom they care: INSERT NAMES AND/OR POSITION IN
CONGREGATIONAL LEADERSHIP.

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I have reviewed this covenant and agree to abide by its provisions. I agree that if I violate this
agreement, I will be denied access to future church functions and church property.

I understand that this contract will be reviewed regularly every six months and will remain for an
indefinite period.
_______________________________ ___________
Signature Date
_______________________________ ___________
Witness Date
_______________________________ ___________
Minister Date
_______________________________ ___________
Director of Religious Education Date
_______________________________ ___________
Board President Date

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Appendix a. Driver Qualification for Transporting Minors
This form will be stored in a locked file cabinet

To protect the safety of our children, it is church policy that any individual driving in any official
capacity for First Unitarian Church Philadelphia, and transporting minors as passengers (other than his
or her family members), shall meet the following qualifications:
1. Possess an adult driver’s license valid in Pennsylvania
2. Demonstrate Evidence of Financial Responsibility for the vehicle being operated, as required by
Pennsylvania law
3. Be at least twenty-one years of age
It shall be the responsibility of the ministry team, task force, First Church staff member or volunteer in
charge of a church function or activity to ensure that these qualifications are met by obtaining from each
prospective driver a completed Driver Qualification Form. This form shall be completed in full by the
prospective driver:
Completed Driver Qualification Forms shall be filed promptly with the church office and will remain
valid through the end of the program year during which the form was completed.
For the purposes of this policy, “functions and activities under First Unitarian Church of Philadelphia
auspices” will include both scheduled and spontaneous activities, whether programmatic, operational, or
social, that are sponsored, led, or directed by ministry teams, task forces, staff members, or designated
volunteers of First Church.

Please fill in the following information:

Name (as shown on driver’s license):________________________________________________________
Address: ___________________________________________________________________________
City: _____________________________________ State:_____________ Zip: ___________________
Driver’s license number: ________________________________ expiration date: _________________
Automobile # 1
Insurance company: __________________________________________________________________
Insurance policy number: ______________________ Insurance expiration date: __________________
Year, make, and model of automobile: ____________________________________________________
License number of automobile: __________________________________________________________

Automobile #2
Insurance company: __________________________________________________________________
Insurance policy number: ______________________ Insurance expiration date: __________________
Year, make, and model of automobile: ____________________________________________________
License number of automobile: __________________________________________________________

By signing this form I agree that the information provided on it is true, and that I am at least 21 years of age.

Signature: _____________________________________________________

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Appendix c. Background Investigation Authorization Form
This form will be stored in a locked cabinet.
This form is to be completed by any applicant for any position involving interactions with minors. The purpose of
this form is to help First Unitarian Church of Philadelphia provide a safe and secure environment for the children
and youth that participate in programs sponsored by the church. Any information you provide here will be kept
confidential and used solely for the purpose of determining your qualifications for working with minors.

Date:_____/ ______/ _____ Date of Birth: _____/_____/ _____ Gender: ________

Social Security # (required to conduct background check): ________/______/_______
Name: First__________________ Middle__________________ Last____________________________
Street Address: ______________________________________________________________________
City: _______________________________________ State:___________ Zip code:________________
Home phone: ___________________________ Other phone:__________________________________
Work phone: ___________________________ e-mail:_______________________________________

List all your addresses for the past 7 years, starting with the most recent (you must include present address):
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Have you ever been convicted of a crime (other than minor traffic offences)? Yes____ No____
If yes, please explain charges: (use additional paper if necessary): ______________________________________
___________________________________________________________________________________________
What state, what county and what year did these convictions occur? ____________________________________
Other names you have used, including maiden names and the date(s) the name(s) changed:
___________________________________________________________________________________________
References: Please list names and addresses of three persons (not relatives) having knowledge of your
character, experience, work habits and ability:
Name Address E-Mail Phone

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Church History and Prior Work with Children and Youth
Are you a member of First Unitarian Church of Philadelphia?  Yes  No
Length of time associated with First U Phila: ___________
If your participation at First U Phila is under 6 months, list any other UU congregations you have
attended regularly in the past 3 years:
Name of Congregation City and State Dates of Attendance

Please list previous church and non-church work involving children and youth:

Driving
If you will be driving minors to church sponsored events, please fill out the Driver Qualification for
Transporting Minors form.

Applicant’s Statement
I authorize the First Unitarian Church of Philadelphia and their agents to investigate my background as it
pertains to employment, appointment or volunteering considerations. I hereby release all persons,
companies or corporations furnishing such information from liability and responsibility.
I understand that any information obtained about me through this application process will be kept in the
strictest confidentiality among appropriate members of First U Phila who will be screening applicants
for compensated or volunteer positions. Any information obtained through this process which indicates
that I may lack, in First U Phila’s opinion, the maturity or temperament to work with children or youth,
will be sufficient grounds for denying this application.

I authorize the First Unitarian Church of Philadelphia or its agents to conduct a criminal history and
sexual abuse background check. I understand that results of that test will be kept in confidence.

Signature: _________________________________________
For office use only:
Application Reviewed by:
______________________
Date:__________________

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Appendix d. Field Trip Permission Form and Consent for Emergency Medical
Treatment
(Please fill out a separate form for each child.
Chaperones will keep a copy and a copy will be kept in a locked cabnet in the church office)

Name of child: ________________________________________________Gender: (circle) M / F Date of birth:_________________

Is this a recurring trip? Y / N Date or dates of trip:_________________________________________________________________

Purpose of trip: __________________________________________________________________________________________________

Destination: _______________________________________________________________________CRE class: _____________________

Parent(s) or Legal Guardian(s):

Name(s):__________________________________________________and___________________________________________________

Address: ________________________________________________________________________________________________________

Home phone: __________________________ Work: _____________________________ Cell phone: _____________________________

Alternate contact person(s) for emergencies

Name(s):________________________________________________________________________________________________________

Address: ________________________________________________________________________________________________________

Home phone: __________________________ Work: ____________________________ Cell phone: ______________________________

Medical Information

Insurance Company: ___________________________________ Group # _________________ ID# __________________

Permission/Authorization
I (the undersigned) am the parent or legal guardian of the above named child. He/she has my permission to participate in the
outing(s) or field trip(s) specified above.

I authorize any of the adult teachers or advisors assisting in the field trip/outing to take any reasonable action to protect the
safety, health and welfare of my child. In case of a medical emergency, I authorize any adult teacher or advisor to administer
first aid treatment to my child and, if necessary in his or her judgment, obtain medical treatment (including surgery) for my
child by any medical care provider. I also authorize the adult teacher or advisor obtaining such medical treatment for my
child to give, on my behalf, any written consent for such medical treatment that is customarily required by the medical
provider, including written consent that releases the medical provider from liability.

The following allergies, medications and other medical issues should be made known to teachers or providers of medical
treatment:

______________________________________________________________________________________________

I understand that my child is expected to behave in a respectful manner to other members of the group, as well as any
persons he/she encounters during the trip. He/she will be expected to obey the adult teacher/advisor’s requests with respect
to safety and group needs. Failure to do so could disqualify my child from future participation.

Signature of Parent or Guardian: __________________________________________________Date: _________________

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Appendix e. Overnight Medical Information Form
This form will be kept with chaperones at all times in case of an emergency. A copy will be kept in a locked
cabinet in the church office.

Participant’s Name _________________________________________________

Please list all:

Allergies, Medical Concerns or Conditions
___________________________________________________________________________________________
___________________________________________________________________________________________
Dietary special needs to accommodate
___________________________________________________________________________________________
___________________________________________________________________________________________

Medications being taken while on the trip.

Medicine:_____________________________________Dosage:_______________________________________
Medicine:_____________________________________Dosage:_______________________________________
Medicine:_____________________________________Dosage:_______________________________________

Parents/guardians may request chaperone keep possession of medications during the event and administer them as
instructed. Please list medications taken independently and any you wish to be held by, administered or confirmed
by chaperone:

Is your child permitted to be given Tylenol or ibuprofen if needed?  YES  NO

Is your child permitted to be treated with topical antihistamine if needed?  YES  NO

Please provide any comments you wish that may help the participating adults provide a positive experience for
your child.

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