Appendix E

CONSENT AND RELEASE

For Background Checks

As a part of my participation in working with children/youth of the Hope United Methodist Parish Churches (Bagley UMC, Bayard UMC, Cooper UMC, Dawson UMC, Linden UMC, Yale UMC), I hereby consent, to and authorize (check those that apply):

_____ Bagley United Methodist Church

_____ Bayard United Methodist Church

_____ Cooper United Methodist Church

_____ Dawson United Methodist Church

_____ Linden United Methodist Church

_____ Yale United Methodist Church

_____ Hope United Methodist Parish

to conduct the following background checks: criminal records, sex offender registry, and child abuse registry. I am willing to have pertinent information shared with the pastors and administrative board of the church. I release the Church, the Hope United Methodist Parish, its employees or volunteers from any and all liability associated with conducting the above background checks. I affirm I have no objection to these checks.

________________________________ ____________________________

Signature Date

________________________________ ____________________________

Printed Legal Name Social Security Number

________________________________

Date of Birth (Month/Day/Year)

Please list ALL legal names that you have been known by, including maiden name, if applicable.