Authorization for Release of Information
For Participant Screening by Embark Safety, LLC
Driver Record Screening Disclosure
I hereby authorize Embark Safety, LLC and its designated agents and representatives to conduct a comprehensive review of my driver record background through a consumer report and/or an investigative consumer report to be generated for participant. I understand that the scope of the consumer report/investigative consumer report may include information about my names, motor vehicle records, and/or license verification. Upon request, Embark Safety, LLC will supply a copy of the completed consumer report along with a copy of an individual’s rights under the Fair Credit Reporting Act.
Authorization and Release
I, authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporations, or public agency may have. I authorize the full release of the information described above, without any reservation, throughout the duration of my driving tour with Appalachian Driving Experience. I hereby release Embark Safety, LLC and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family or associates because of compliance with this authorization for release form. I certify that all information provided below is correct to the best of my knowledge. This authorization and consent shall be valid in original, fax, email or copy form. The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose.
Date: January 28, 2020