This form must be completed by the applicant's parent or legal guardian.

By signing below, the undersigned parent/legal guardian authorizes Background Screening Consultants LLC (DBA SafeScreener) and its screening partners to obtain background information about the Minor for a permissible purpose in connection with the Minor’s application, participation, placement, or eligibility (e.g., employment, volunteer, student, program participant, or similar role) with the organization identified below, as allowed by applicable law.

Minor information

Minor full legal name:

Minor date of birth:

Organization applying with:

Parent / legal guardian certification

• I am the Minor’s parent or legal guardian and have legal authority to provide this consent.
• I authorize BSC/SafeScreener to obtain background information about the Minor, including consumer reports and/or investigative consumer reports where permitted, for the purpose stated above.
• I understand that the information may be used by the organization identified above to make decisions regarding the Minor’s participation/eligibility.
• I understand I may request a copy of any investigative consumer report (if obtained) as permitted by law.
• I understand that providing consent is voluntary; however, the Minor’s eligibility to participate may depend on the organization’s requirements and applicable law.

Relationship to Minor:

By typing my name below and providing my digital signature, I am providing SafeScreener permission to perform the required applicant background check on my child or minor under my legal care.