Consent to Process Background Check

CONSENT TO PROCESS BACKGROUND CHECKS

Having made application to work with minors at Lakeside Baptist Church (Lakeside Baptist) and desiring the church to be informed as to my past record and character, I authorize any persons, references, employers, churches, or organizations with whom I have had any contact to release to Lakeside Baptist any information (including opinions) they may have regarding my record, character, and fitness for work with minors. I also authorize Lakeside Baptist, at its discretion, to contact any law enforcement or social service agency to determine whether I have ever been charged or convicted of a crime, and I authorize such agencies to release such information to Lakeside Baptist. I fully release Lakeside Baptist, its agents, and all persons, organizations, and agencies from any right or claim of confidentiality and from all claims, actions, or causes of action which may arise as a consequence of exchanging such information, and I waive any right that I may have to inspect any such information, letters or statements, provided on my behalf.
Full Legal Name*
Maiden Name
Address
Date of Birth

MonthDayYear
Date
Email*
example@example.com
What ministry are you volunteering for?

PreschoolChildrenYouthVBSChoir (Preschool, Children, Youth)
Social Security*
Drivers License*
Signature*

Clear
Date

MonthDayYear
Date
Please return this form to: Child Protection First Coordinator, Lakeside Baptist Church.

A PHOTOCOPY OF THIS AUTHORIZATION SHALL HAVE THE

SAME EFFECT AS THE ORIGINAL.
Should be Empty: