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At Guardian Hills, the safety of our participants, staff and volunteers is of utmost importance. Background checks play a critical role in establishing trust and safety within any organization. As a key mechanism for vetting participants, staff and volunteers, Guardian Hills conducts background checks through the Missouri Automated Criminal History Site (MACHS) for all individuals involved. This background check will be completed prior to arriving for the Guardian Hills Retreat Program and will be utilized only within the organization.

Please note that criminal record information is considered public record and that individuals may choose to self-disclose any information to Guardian Hills prior to the submission of their MACHS background check to assist us in our vetting process.

Findings of recent prior violent criminal conviction, recent drug or substance arrest or sex offender information may disqualify a potential candidate from participation in the Guardian Hills Retreat Program as staff, volunteer or participant. Records will be reviewed on an individual basis.

First Participant's Name
First Name*
Middle Name
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
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ALIAS #1 (INCLUDING MAIDEN NAME)
ALIAS #2 (IF APPLICABLE)
DATE OF (VERBAL) CONSENT TO BACKGROUND CHECK SUBMISSION
PERSON WHO OBTAINED VERBAL CONSENT
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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