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 all adults are approved to work with youth. Please confirm using this form that adults are trained in Safe Gatherings, Safe Sanctuary, or another such training that your church uses. This includes ALL youth and adult participants 18 years or older. If no such training exists, please confirm that your church has run a background check that includes a criminal background check as well as a child maltreatment registry check for all adults. This form is used by groups attending to certify the completion of this task.
Name of Church
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Church Contact
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First Name
Last Name
Church Contact Phone Number
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-
Area Code
Phone Number
Church Contact Email
*
example@example.com
Mission Week Dates
June 7-12
June 21-26
July 12-17
Mission Location
*
Please Select
Bentonville
Fayetteville
Rogers
Paragould
Little Rock
Maumelle
North Little Rock
Cabot
Shoal Creek
Arkadelphia
Please List the names of the adults attending with your group. By listing below you certify that these adults have been trained and certified to work with youth, or 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.
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By signing below, I acknowledge that the church listed above has approved and trained all adults 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.
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Questions?
Contact Ashley Vaughan by email at avaughan@ozarkmissionproject.org.
Submit
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