Saline Area Youth Baseball & Softball
2019-2020 School Year
Consent To Conduct 
State of Michigan IChat Criminal History Background Search 		

Intended Time Frame:	 Purpose / Activity: _____________
Current Legal Name:	            ____________________           ______________________
First	Middle	Last
Maiden Name / Names Previously Used:        _______________________________________________
Birthdate:	 Ethnicity:	
Gender:      ____________________
Have you ever been charged with, arraigned for, plead guilty to, or convicted of criminal charges? 
I understand that:
•	The above information is required by the Michigan State Police to perform an IChat criminal history background
check. I authorize Saline Area Youth Baseball and Softball (SAYBS) to utilize this information for the sole purpose of obtaining conviction only criminal history file searches and understand the sexual offenders website will also be searched. If changes occur in regard to the above disclosed criminal history information, I understand I am required to inform the Saline Area Youth Baseball and Softball President and Treasurer within 48 hours. I hereby certify the above responses as accurate and understand that providing fraudulent information is cause for immediate denial or revocation. 
•	The information obtained as a result of the search of my criminal history will be used by Saline Area Youth Baseball and Softball to determine appropriateness and suitability of placement, assignment, and access within the organization.
•	I may be dealing with confidential information, and I agree to keep said information in the strictest of confidence.
•	My relationship with SAYBS is “at will” and may be terminated by the district at any time without cause.
Signed 
Date: ________	Volunteer	For Office Use Only:
	Date Checked:	
	SAYBS Clearance:	⧠ Approved	⧠ Denied
	By: