State College YMCA Release Form | South Hills School of Business & Technology

State College YMCA Registration

Beginning Spring Term 2019, all South Hills students, faculty, and staff who wish to make use of the State College YMCA facilities are required to complete this form.

By completing this form, you are authorizing South Hills School of Business & Technology to submit your name and date of birth to the State College YMCA for the purpose of running a sex offender background check.

You will receive an email confirmation after you've submitted your information. Please retain this confirmation email as proof of submission.

Personal Information
Name*
Prefix First Middle Last Suffix
Date of Birth*
Month
Day
Year
Email Address*
Enter your South Hills provided email address.
Enter Email Confirm Email
Authorization
Information Release Authorization*
By checking this box, I authorize South Hills School of Business & Technology to share my information with the State College YMCA for the purpose of running a sex offender background check on me.
- I authorize South Hills to release my information to the State College YMCA.
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State College YMCA Registration

Personal Information

Authorization