Background Check Form

Background Check Form

All Staff 14+ Need to Submit This Form
I am STAFF at which WI District UPCI Camps? (Choose ALL camps that you are attending as STAFF)

Kid's CampYouth CampFamily CampSpanish CampMen's CampOther
I hereby authorize any person making inquiry on behalf of the Wisconsin District UPCI Camp, PO Box 670, Reedsburg, WI, 53959 to obtain any information from police departments and any other criminal justice agencies relating to any criminal record. This information may include, but is not limited to, arrest and conviction records. I hereby direct you to release such information upon request, whether favorable or unfavorable, to any representative of the above-named institution presenting this authorization or a photocopy or facsimile copy of it. In order to assist in the compilation of this information, I hereby give the following information:
Name*

Last NameFirst NameMiddle Name
Gender

MaleFemale
Race*
Date of Birth*

MonthDayYear
Date
Alias, if any (Including maiden name)
Phone Number*
Please enter a valid phone number.
Copy of Drivers License or Photo ID*

If you are a minor without a Driver's License or Photo ID, just submit a photo.
Cancelof
Should be Empty: