Lewiston & Porter Youth Athletics

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Coach & Volunteer Consent to Criminal Background Check

* Last Name:

* First Name:

* Middle Name or Initial:

* Street Address:

* Date of Birth:

* Town or City:

* Zip Code:

* Social Security Number:

* Phone Number:

* Player and Division you are coaching?:

* What division will you be coaching?who are you coaching with?:

Please have your assistant coaches fill out a consent to criminal background as well

I, the above named volunteer or coach, hereby give my consent for Lewiston Recreation to perform a Criminal Background Check in conjunction with the Lewiston Police Department and/or a third party firm. I, the above named, also grant the Town of Lewiston permission to investigate any criminal record that we may deem as possibly harmful or disruptive to Lewiston Recreations ability to provide programs to children. The Town of Lewiston and its agents, partners and employees retain the right to refuse the request of anyone to volunteer in any of its programs.

I have read the above and consent to a Background Check. *

* indicates required fields

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Coach & Volunteer Consent to Criminal Background Check