What area would you like to volunteer?

If you are 18 years or younger, please indicate the grade completed for the 07/08 school year.

If you are a group leader or group helper, check this box if you want your child in your group?

If so, please list child's name and grade completed or age:

SLED Background Check

All adult volunteers (18 years old & up) must complete this form regardless of prior completion.

In order to volunteer with Riverland Hills Baptist Church you must authorize the church to conduct a criminal investigation check. By signing this form you authorize Riverland Hills Baptist Church to check your background for any criminal records.

It is important that you understand that no person will be considered to serve as a volunteer who has been convicted of, placed on regular or deferred adjudicated probation, received pre-trial diversion, pled guilty or nolo contendore to any offense involving child pornography, sexual contact or physical abuse with a child/student.

I hereby authorize Riverland Hills Baptist Church to conduct a criminal background investigation on me. I understand and accept the conditions listed above.

The following information is required by law enforcement agencies and other entitles for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes.

Maiden or other names used:

Birthdate:

Driver's License #:
State:

Name as it appears on DL Number:

Home Address:

City/State & Zip:

Phone:

Work Phone:

Check if you have ever been convicted of a crime.

If yes, details...