CRIMINAL OFFENDER RECORD INFORMATION (CORI)
SEX OFFENDER RECORD INFORMATION (SORI)
ACKNOWLEDGEMENT FORM

Andy Yosinoff’s Cheer and Dance Clinics is registered under the provisions of M.G.L. c. 6, § 172 to receive CORI and under the provisions of M.G.L.c.6. § 178I to receive SORI for the purpose of screening current and otherwise qualified volunteers coaches.

As a volunteer coach, I understand that a CORI/SORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide permission to Andy Yosinoff, a CORI certified administrator and a SORI requester, to submit a CORI/SORI check for my information to the DCJIS. The authorization is valid for one year from the date of my signature. I also understand that this form is a CORI/SORI acknowledgement form and I am entitled to additional consumer reporting disclosure forms under the Fair Credit Reporting Act.

Andy Yosinoff may conduct subsequent CORI/SORI checks within one year of the date this form was signed by me provided, however, that Andy Yosinoff must first provide me with written notice of this check.

By signing below, I provide my consent to a CORI/SORI check and acknowledge that the information provided on Page 2 of this Acknowledgement Form is true and accurate.

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Date __________________________