This SECURE form will:
1) Give us information needed to check your background clearance status and expiration date.
2) Is your legal consent to secure your background check through the Dept. of Children & Families &/or other background services as needed.
3) We MUST have this document on every person coming as a leader or camp staff.
If you have any questions, or would be more comfortable giving your information over the phone, you may call us: Office number 850-482-3844
Please read the following authorization and release, then fill out the form questions to help us best serve you.
AUTHORIZATION AND RELEASE
By submitting this form, you have filed an application as a summer camp worker with the West Florida District Council of the Assemblies of God, and consent to have an investigation made as to the conduct of my personal affairs, my moral character, professional reputation and fitness for the ministry and such further information as may be received by or reported to the West Florida District Council of the Assemblies of God. I agree to give any further information which may be required in reference to my past history.
I authorize and request every person, firm company, corporation, government agency, court, association, church education facility, or institution having control of any documents, records, and other information pertaining to me, to furnish to the West Florida District Council of the Assemblies of God any such information including documents, records, or other information regarding charges or complaints filed against me, formal or informal, pending or closed, and to permit the West Florida District Council of the Assemblies of God or any of its agents or representatives to inspect and make copies of such documents, records, and other information. The West Florida District Council maintains the right to release any information pertaining to the background check to any person or organization deemed necessary. I specifically waive any and all right I may have to inspect or review any information provided to the West Florida District Council of the Assemblies of God, its agents or representatives by any persons or organization.
I hereby release, discharge and exonerate the West Florida District Council of the Assemblies of God, its agents and representatives and any person furnishing information from any and all liability of every nature and kind arising out of furnishing or inspection of such documents, records, and other information or the investigations made by or on behalf of the West Florida District Council of the Assemblies of God. The West Florida District Council of the Assemblies of God shall not be required to verify any information received during the course of its investigation, and shall not be liable for acting on the basis of any information which later appears to have been false or incomplete.
Instructions on how to obtain a background check or see if your prints have expired, please select the appropriate camp for that information. Kids Camp / Youth Camp