C/V Background Check |

Background Record Check Release Form – Coaches and Volunteer Staff

Champions is required to conduct a Background Record Check on all Coaches and Volunteer Staff 18 years of age or older on the day Camp starts. If you are 18 or over, please complete and submit the form below. The fee is $20 – included in your Registration payment. Thanks!

Background Record Check Release

All items are REQUIRED.

Name*
First Last
Email*
We'll notify you by email that we successfully received your form...

Enter Email Confirm Email
Address*
Street Address Address Line 2 City State ZIP Code
Social Security Number*
(format is: ###-##-####)
Date of Birth*
Do you have a Driver's License?*
- Yes
- No
Driver's License Number*
License Issued in what state (ex: KS)?*
Authorization for Background Check

I authorize the investigation of any or all statements provided during the process of this application, and I hereby release said organization from all liability for any damages for issuing this information concerning my background. I authorize the investigation of any or all statements provided during the process of this application, and I hereby release said Organization from all liability for any damages for issuing this information concerning my background Records.

I understand and agree that in the event I am offered an opportunity to serve, it is contingent upon my passing criminal background checks, the sexual offender registry check, and any other screening tests as may be required. I agree to consent to those checks at such time as designated by the Organization and to release the Organization, its directors, officers, agents or employees from any claim arising in connection with the use of such background checks.
Select Today's Date*
Full Signature*
I'm 18 or older on the day Camp starts, I have read and understand the Authorization statement above, and I hereby authorize Special Needs Health Center to conduct a required legal Background Check using my name, address, SSN, Driver's License info, and date of birth. (Add your signature using your mouse or touchscreen.)

Background Record Check Release

Authorization for Background Check