__________________________________________________
Camp, Clinic/Instructor Name

CAMPS, CLINICS AND PRIVATE LESSONS
BACKGROUND CHECK NOTIFICATION FORM

I_____________________________________, understand that a Criminal Background Check will be 
                                            Print Name
conducted as a condition of my employment with ________________________________________________.
                                                                                                                       Camp Name 
In addition, I authorize the sharing of the results of the Criminal Background Check with appropriate California State University, Fullerton personnel.  

                                                                                                               
			
	Employee Signature			Date

___________________________________________                                    ________________________
                                   Camp Director Signature                                                                                                    Date

•	Camp Directors/Head Coaches, keep this form in you’re files, along with proof of a Criminal Background Check for all camp/clinic and private lesson employees.

6/5/07