Background Consent 2017-18

* indicates a required answer.

DasCHE Criminal Background Check Consent Form

The safety of our children is always the main concern at DasCHE.  Therefore, each and every adult who is a member of DasCHE will need to submit to a criminal background check.  This includes all Co-op tutors, in-class helpers at Co-op, substitute tutors, study hall monitors, nursery workers, coaches, and all parents.   Each and every adult who serves during our association and co-op activities needs to submit his/her own information.

1. *

Name on Driver's License  (First  Middle  Last)

2.*

Please check all of the categories where you will serve:

 (1 required)
Co-op Service Hours Co-op Substitute
Co-op Tutor Other
3.

If Other, please list the activity or committee with which you are planning to help.

4.*

Do you voluntarily consent to this background check?

5.*

Have you ever been convicted of any felony?

6.*

Have you ever been convicted of any misdemeanor?

7.*

Do you currently have any felony or misedemeanor charges pending against you?

8. 

If yes (to any of these), please explain:

9. *

Driver’s License #

10. *

State Issued

11. *

Date of Birth   ( mm / dd / yyyy  )

12. *

Current Address

13. *

Phone Number

14. *

Email Address

15. *

By typing your full name and today's date in this box, you are indicating your consent to a criminal background check.

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