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Get Bcf Psrc Authorization And Release For Protective Services Record Check Form

Please complete the following and sign below. All applicants to operate a home, program or facility for the care of children or adults and the adult family members, staff or adult volunteers of such home, program or facility are to complete this form. Please use BLUE INK. Name (Print your full name. Do not use initials): (First Name) (Middle Name) (Last Name) Birth Date: Social Security Number:.

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