The information I have provided in this form may be verified by the contact persons or organizations named in this form (including law enforcement agencies). I hereby release and agree to hold harmless from liability (a) any person or organization that provides information in connection with this form and (b) Montgomery Community Church its officers, employees, and volunteers thereof, in connection with the verification of any information provided in this form.
I affirm that the information I have given in this form is true and correct, and that if there are any changes, I will promptly inform Montgomery Community Church.