RELEASE FORM and DISCLOSURE AGREEMENT
I have signed this Release Form and Agreement as an expression of my commitment to help protect children, young people, and other vulnerable persons who may participate in programs sponsored by the Cumberland Presbyterian Church. Accordingly, I now request and authorize the release of the personal information described below to the church or its agents:
- Any records of arrests, charges, or convictions of me contained in the files of any law enforcement agency or other government entity, whether such file is local, state-wide, or national.
I agree to release, hold harmless, and indemnify any person or organization that discloses information as requested in this Release Form and against any liability, cause of action, or claim of damage that could be brought by me or on my behalf as a result of the release of the information. I understand that the information disclosed may be considered confidential and may be used as the basis of a decision not to permit me to participate as a leader in programs of the church.
My consent to the release of the information described above shall expire six (6) months after the date of this Release. My agreement to hold harmless any person who discloses information as requested in this Release shall not expire.
The following information is required by every person invited to serve in a leadership role in programs and events, especially those involving children and youth. Answering yes to any of the following questions may not disqualify you from consideration, but providing false answers will result in automatic disqualification. Please feel free to attach any explanation or additional information.