Background Check Form

Name*

First Middle Last

Other Names Used

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Have you lived in any other state during the last three years?

No
Yes

If yes, where?

Date of Birth*

Sex*

Female
Male

Driver's License Number

State of Issue

The information contained in this application is correct to the best of my knowledge. I authorized any references, employers or volunteer organizations listed on my Volunteer application to give you any information (including opinions) that they may have regarding my character and fitness for children or youth work. In consideration of the receipt and evaluation of this application by Home Run Hitters International, Inc., I hereby release any individual, organization, employer, reference or any other person or organization (including record custodians), both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result for me, my heirs or family due to compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Should my application be accepted, I agree to be bound by the bylaws and policies of Home Run Hitters International, Inc. I understand that Home Run Hitters International, Inc. desires to protect its' participants and therefore give my permission for them to conduct a criminal background check on me if deemed necessary.

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