Grace Life Baptist - Child Protection Policy Volunteer Application Form
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Consent to Release Confidential Information
Having made application to work with minors at Grace Life Baptist Church and desiring 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 Grace Life Baptist Church any information (including opinions) they may have regarding my record, character, and fitness for work with minors. I also authorize Grace Life Baptist Church, at its discretion, to contact any law enforcement, state authorities, or social services to determine whether I have ever been charged or convicted of a crime and to obtain driving record if needed. I authorize such agencies to release such information to Grace Life Baptist Church. I fully release Grace Life Baptist Church, its agents, and all persons, 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. By typing my full legal name below I state that I am in full agreement of the Consent to Release Confidential Information Form and all its' contents.
Consent to Release Confidential Information Signature *
Address (include city, state, and zip): *
Date of birth: *
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