MARBLEHEAD BOYS YOUTH LACROSSE CRIMINAL OFFENDER RECORD INFORMATION (CORI) ACKNOWLEDGEMENT FORM

MARBLEHEAD BOYS YOUTH LACROSSE CRIMINAL OFFENDER RECORD INFORMATION (CORI) ACKNOWLEDGEMENT FORM
Marblehead Boys Youth Lacrosse, Inc is registered under the provisions of M.G.L. c. 6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective volunteers, coaches, and managers. Marblehead Youth Lacrosse is to submit CORI checks to the Massachusetts Department of Criminal Justice Information Services (DCJIS).

As a prospective or current volunteer, coach or manager, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to Marblehead Youth Lacrosse to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing Marblehead Youth Lacrosse with written notice of my intent to withdraw consent to a CORI check. I also understand that this form is a CORI acknowledgment form.

By signing below, I provide my consent to a CORI check and acknowledge that the information provided below on this Acknowledgement Form is true and accurate.
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