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									                                        CONSUMER REPORT NOTICE AND AUTHORIZATION

                                                   (This is Not a Credit History Check)
         Voyager Academy's Board of Directors requires principals to conduct a criminal record check on volunteers who
may have unsupervised contact with children. Under this policy, the principal of Voyager Academy, Carl Forsyth, has
asked that you agree to undergo a criminal background check. Voyager also may conduct periodic criminal record checks
on you after you start volunteering. If Voyager obtains these criminal record checks from a consumer-reporting agency,
the reports are considered consumer reports under the federal Fair Credit Reporting Act. You are entitled to receive a
copy of any report, if you request it, or if the school system modifies your volunteer status as a result.


         Please complete this form if you authorize Voyager to obtain a criminal history report from a
credit-reporting agency. This is NOT a credit report.

                                                       PLEASE PRINT LEGIBLY.

Name ______ Last _______________________________ First __________________________________ Middle/Maiden ____________________

Mailing Address ___________________________________________________________________________________________________________

City _______________________________________ State _______________________________________________ Zip ______________________

Home Phone _________________________________________________________ __ Birth date ________________________________________

Sex ________________ Race ______________________________ SS# _______________________________________________________________

School: VOYAGER ACADEMY __________________________________________________ Job Title: VOLUNTEER _____________________

North Carolina Driver's License #

List all Counties of Residence in North Carolina


List all Street Addresses

I hereby authorize Voyager Academy to obtain a criminal history report from a credit reporting agency, the North
Carolina State Bureau of Investigation or other agencies, and waive any claim for damages or injury against Voyager
Academy or the provider of the report, except as provided by the Fair Credit Reporting Act.

Volunteer's Signature: ____________________________________ Date _________________

Student’s Name __________________________                            Homeroom Teacher __________________

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