Background Consent Form

Please fill out the Background Consent Form.

Please make sure you either upload, email (www.jc3texas.com), fax (409-384-5373), or bring them in to the church office a copy of your driver’s licenses for us. Our office hours are Monday – Friday 9 am – 1 pm.

 

 

Name:*
Alias Name(s):
Maiden Name:
Address:*
Previous Address:*
Date of Birth:*
 / 
 / 
Driver License #:*
Upload a picture of your drivers license here:

**********PLEASE EMAIL US A COPY OF YOUR DRIVER'S LICENSE**********

I understand that in an effort to protect our youth and children, Jasper County Cowboy Church completes thorough background checks on all individuals who provide care and supervision for them.

I further understand that Jasper County Cowboy Church will hold all information obtained during said checks in absolute confidence and will not resell, release or provide these findings to any party other than required for legal and legitimate purposes.

I understand that a copy of any findings and the source of those findings will be provided to me upon request.

I agree to release from liability and hold harmless Jasper County Cowboy Church and any third party vendor they select to complete these checks provided the findings are accurate depictions of information contained in source documents. Neither Jasper County Cowboy Church, AFCC or the third party vendor they select will be liable for inaccuracies, omissions or deletions in source documents.

Granting Party:*

This will serve as your digital signature.

Date:*
 / 
 / 
E-mail:*

Beyond130 Marketing Services