Background Check Verification Form
In order to promote a safe environment for all youth and adult participants at Ozark Mission Project, each group must certify that it has conducted a background check on all participants who are 18 years or older. This includes ALL youth and adult participants 18 years or older. The background check must include a criminal background check as well as a child maltreatment registry check. This form is used by groups attending to certify the completion of this task.
Name of Church
*
Church Contact
First Name
Last Name
Church Contact Phone Number
*
-
Area Code
Phone Number
Church Contact Email
*
example@example.com
Mission Week Dates
June 9-14
June 23-28
July 14-19
Mission Location
*
Please Select
North Little Rock
Forrest City
Conway
West Memphis
Central AR (Maumelle)
Bentonville
Fayetteville
Mount Eagle
Please List the names of the adults attending with your group. By listing below you certify that you have conducted a criminal background check and a child maltreatment registry check on all persons 18 years and older attending an Ozark Mission Project event with your group.
*
By signing below, I acknowledge that the church listed above has conducted a criminal background check and a child maltreatment registry check on all persons who will be chaperoning or working with youth at Ozark Mission Project on and that all such participants have been approved by the local church to work with children, youth, and other adults. The local church named in this form agrees to indemnify, protect, and hold harmless Ozark Mission Project, its staff and volunteers from any and all liability, actions, causes of actions, claims, or demands of any kind or nature, whether foreseen or unforeseen, known or unknown, that are in any way connected with the attendee’s(s) attendance or participation with the Ozark Mission Project.
*
Questions?
Contact Jules Anderson by phone (479.212.8017) or by
email.
Submit
Should be Empty: