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Background Check Consent 22-23

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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 which category best describes your involvement in DasCHE Scholastic Co-op:

 (1 required)
Parent of DasCHE Student/Adult Member Co-op Tutor
Preview Day Participant Guest Speaker
Other
3. 

If Guest Speaker, please specify the tutor and class you are speaking in.

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.