I hereby request all applicable agencies to release any information which pertains to any record or convictions contained in its files or in any criminal file maintained on me whether locally, state or nationally. I hereby release all applicable and relevant agencies from any and all liability resulting from such disclosure.
The information contained in this application is correct to the best of my knowledge. I authorize any references of churches listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for child or youth work. In consideration of the receipt and evaluation of the application by Shepherd of the Hills, I hereby release any individual, church, youth organization, charity employer, reference, or any other persons or organization, including record custodians, both collectively and individually, from any and all liability or damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of 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. I HAVE CAREFULLY READ THE FOREGOING RELEASE AND UNDERSTAND THE CONTENTS THEREOF AND I SUBMIT THIS RELEASE FREELY AND VOLUNTARILY.