I understand and agree that submitting this application form does not automatically register me as a volunteer with Urban Street Angels, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

I recognize that beginning volunteer service is conditional on my successfully passing reference and background screening, if any.  I understand that Urban Street Angels (USA) may conduct Reference and Background Checks thoroughly and within the confines of all applicable state and federal laws.

In consideration of USA’s review of my volunteer application, I hereby release, discharge and exonerate USA, its agents, employees, assigns, and representatives and any individuals or entities furnishing information from any and all claims or liabilities that might arise from the inquiry into or disclosure of such information, including claims under any federal, state or local civil rights law and any claims for defamation or invasion of privacy.

I hereby voluntarily consent to and authorize USA, or its authorized representative bearing this release or copy thereof, in connection with my volunteer application with Urban Street Angels, to conduct inquiries related to my character, general reputation, personal characteristics, or mode of living.  This information may include but is not necessarily limited to Criminal and Civil History, Certification and Licensing (if required for volunteer position), Educational Credentials (if required for volunteer position), and Reference Checks.

I authorize all persons who may have information relevant to this research to disclose such information to USA, or its agents, and I hereby release all persons from liability on account of true and accurate disclosure.

I understand that I will be immediately informed should the background check reveal some adverse information.  If no adverse information is received, I will not receive any further communication on this issue.

By submitting this form, I attest that the information I have provided on the form is true and accurate.