CHAPTER 6, 172h CORI REQUEST FORM

South Coast Girls Softball, Inc. is requesting all the available criminal offender record information (CORI) on the following individual from the Criminal History Systems Board pursuant to Chapter 6, 172H which mandates organizations primarily engaged in providing activities or programs to children 18 years of age or less that accepts volunteers, to obtain all CORI regarding volunteers prior to accepting any persons as a volunteer.

VOLUNTEER INFORMATION (PLEASE PRINT)
 

                                                                                                                           
Last Name                               First Name                       Middle Name

                                                    
Maiden Name or Alias

Date of Birth:                                           License Number                                    

Address:
                                                                                     


                                                                                       

Requested By:                                                                    
                               Signature of CORI Authorized