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2023-2024 Background Check Authorization

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Thank you for being part of SHINE!

By typing each name, you are confirming that you authorize SHINE to conduct a background check on your behalf.  Background check results are held in the strictest confidence and are used only to keep our children safe. Your typed signature below represents your written signature and will be your written agreement.

Background check fees are $25/family for members.  There is no charge for guests or visiting teachers.

1. *

Date:

2. *

Signature and Date of Birth:

3. 

Additional Adult Signature and DOB:

4. 

Additional Adult Signature and DOB:

5. *

Email Address:

6. *

Phone Number:

7. *

Current Address:

8. 

Previous Address (if in the last 3 years):