Reverb Kids Background Check (0-4th Grades Only) Please take a moment and fill out the information below. Name*FirstLastDate of Birth * Address*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP CodeMobile Number with Area Code *May we send you text messages *Yes No Email*Sex *MFMarital Status Single Married Do you have any children?YesNoIf Yes to Above, Please list their names and ages Social Security # - (Secured Doc)*Driver's License Number Please provide your DL# if you posses one. Have you ever been charged with, indicted for, or pled guilty to an offense involving a minor?YesNo If yes, please describe all convictions for the past five years.Please select the age(s) group you are interested in serving. *Registration0-5 Yrs.K-4th Grade 5 & 6th 7th -12th Grade You may select multiple choices ***Digital Signature. I certify that the information given on this form is true and correct to the best of my knowledge. I understand that as a volunteer working with children, youth, and/or vulnerable adults, I am subject to a thorough background check including criminal history. *Please type your name in the section below. This will serve as a digital signature once you submit this form.