Ronald McDonald House Charities of The Miami Valley Region (“RHMC-MVR”) conducts a criminal history background check on all individuals (18 years old or older) applying for temporary residence at the Ronald McDonald House of Dayton. In determining eligibility for temporary residence, RHMC-MVR screens family behavior and an individual’s suitability for temporary residence among other families. A criminal conviction record which reveals behavior that may adversely affect another individual’s (e.g., other temporary residents, guests, staff, volunteers) health, safety, welfare and ability to peacefully enjoy the RHMC facility shall result in your application for temporary residence being denied. For example, and without limitation, convictions of violent crimes, domestic violence, child abuse, sex offenses, illegal drug activity, burglary, and/or identity theft will result in rejection of your application.
This form includes a Criminal History Background Report Authorization form for you to review and sign. Each family member or visitor (18 years old or older) who intends to apply for temporary residence must separately fill out this form and the Criminal History Background Report Authorization form. Once we receive the completed form, RMHC-MVR will have an independent third party conduct a criminal history background check.
Ronald McDonald House of Charities of The Miami Valley Region (RMHC-MVR) will attempt to obtain and use a criminal history background “consumer report” from a “consumer reporting agency” when considering your application for temporary residence while your child (or family relation) is receiving medical treatment at Dayton Children’s Hospital, Miami Valley Hospital, or another area hospital. These quoted terms are defined in the FCRA, a law which RMHC-MVR deems to apply to you. As an applicant for temporary residence at our facility, RMHC-MVR is considering you to be a “consumer” with rights under the FCRA.
Please understand that RMHC-MVR solely will obtain a criminal history background report to assist it in determining whether to grant you temporary residence. RMHC-MVR is not obtaining a “consumer report” for any other information and will NOT be conducting a credit check.
If RMHC-MVR considers any information in the criminal history background report when making a temporary residence decision that directly and adversely affects you, you will be provided with a copy of that report. You also may contact the Federal Trade Commission about your rights under the FCRA as a “consumer” with regard to “consumer reports” and “consumer reporting agencies.”
To assist RMHC-MVR in obtaining criminal history background check information, please truthfully and completely answer the following question: