Background Check
Serving children under the age of 18 at Bethel Valparaiso requires a background check. Please submit this form to complete your background check.
First Name: *
Your answer
Middle Name: *
Your answer
Last Name: *
Your answer
Home Address: *
Your answer
Phone Number: *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender: *
Race: *
I promise to report any signs of emotion, verbal, or physical abuse that I suspect to a Bethel Valparaiso Staff Member. *
I promise that I will remain confidential when working with children. Not using names when telling stories or testimonies, without parent permission. *
I promise to only post pictures on social media after checking with Chelsey to confirm that parent permission has been given. *
I promise that all information on this form is to my best of knowledge correct. *
I give Bethel Valparaiso Staff permission to complete an Indiana Criminal Background Check for the name on the top of this form. Please type your name. *
Your answer
Please select the date. *
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This form was created inside of Bethel Valparaiso - All Nations Church. Report Abuse - Terms of Service - Additional Terms