Background Check Authorization - River City Believers Academy

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In order to enhance student security at River City Believers Academy, I authorize the administration of RCBA to obtain any criminal history record information. I understand that this may include a search of local, state, and/or federal law enforcement agency records and hereby expressly release any and all information these agencies may provide.
If there is a need for clarification of my identity, I agree to provide additional information including, but not limited to, photographs and fingerprints.
Name (First, Middle, Last) *
Present Address *
Address 1
Address 2

City

State

Zip
Date of Birth *
Phone Number *
Ethnicity * (1 required)
American Indian/Alaskan Native Asian/Pacific Islander Black Hispanic White Other
Gender * (1 required)
Male Female
Driver's License Number *
Driver's License Issued State *
Authorization
I agree that by checking this box, I am providing my electronic signature and consent. I understand
Enter Your Email Address: *