Background Checks for Kentucky Caregivers Seeking Childcare
Registration Fee

WAIVER AND RELEASE OF LIABILITY

PREVENT CHILD ABUSE KENTUCKY, INC.

In consideration for receiving child abuse and criminal background check services paid for by Prevent Child Abuse Kentucky, Inc. (“PCAK”) and administered by the Kentucky Department for Community Based Services (“DCBS”) and the Kentucky Administrative Office of the Courts (AOC) (“Background Check”), I, the undersigned, hereby agree as follows:

I, for myself and my estate, heirs, administrators, executors, and assigns (“Representatives”), hereby acknowledge and agree that PCAK does not participate in, administer, supervise, control, deliver, manage, execute, contribute to, engage in, or play any role in the Background Check, except providing payment for the services performed by DCBS and AOC. I further acknowledge that PCAK does not warrant, guarantee, or assure the outcome or results of Background Check.

I, for myself and my Representatives, hereby expressly release and covenant not to sue PCAK and its officers, directors, employees, representatives, agents, affiliates, and volunteers (“Releasees”) from any and all liability associated with Background Check, including any and all claims, damages, losses, causes of action, costs or expenses of any kind or nature whatsoever, injuries, pain and suffering, death, or property damage, whether foreseeable or unforeseeable, anticipated or unanticipated, that I, or my Representatives may have arising out of, connected with, or in any manner pertaining to the Background Check.

I shall indemnify and hold PCAK and Releasees harmless from and against any claims by me or my Representatives as a result of Background Check.

 

You must be a Kentucky resident to participate in this program.

Contact Information:

* Denotes a mandatory field
Mr.Ms.Mrs.Dr.
*First Name: *Last Name:
Title: Company/Organization:
*Mailing Address:

*City: *State/Province:
Country: *Zip/Postal Code:
*Telephone: Extension:
*Email Address:


Event-Related Questions:

* By checking this box, I have read the waiver and release above, understand and accept the risks associated with the background check, understand I am giving up substantial rights by signing this waiver and release, and voluntarily agree to be bound.
I agree
* Name of individual you will be seeking the background checks on
* Number of children who will be in the care of the above individual
Ages of children (select all that apply)
Infant 0-1 year of age
2-4
5-9
9 and up
* Please indicate the approximate hours per week this caregiver will be responsible for your child/ren.
* The provider specified above is part of an in-home service caring for more than three unrelated children, operating a learning pod or watching my child as part of a child care facility. These types of child care are not eligible for this opportunity.
Yes. Please refer your provider to the Division of Child Care https://chfs.ky.gov/agencies/dcbs/dcc/Pages/childcareproviderinfo.aspx to ensure they meet state operating guidelines.
No.
* Select all that apply.
Background checks are only one step needed to ensure your child’s safety when choosing a child care provider or babysitter. The following list outlines considerations when selecting someone to care for your children. Your answers to the questions will not be taken into consideration when funding your background checks. They are for your educational purposes, only.
I have checked with others who know or have used this individual in the past to ensure their experience was positive and there are no concerns.
I have asked, or plan to ask for references and contacted or plan to contact references in regard to the person caring for my child/ren.
I have asked, or plan to ask what type of experience this provider has with children.
I have observed, or plan to observe this caregiver with my child/ren and feel confident in his/her ability to work with my children and provide for their safety.
I have asked, or plan to ask what type of activities the caregiver plans to do with my child/ren during the day.
If my child is being cared for outside of my home, I have, or will make sure the environment is appropriate, safe, clean and free of hazards such as firearms, medicine or weapons.
I know, or I will find out, how many other children this provider is watching while caring for my child/ren.
I have discussed, or will discuss transportation and the expectations for transporting my child/ren.
I have discussed, or plan to have a discussion with this provider regarding my expectations regarding my child/ren’s care, including my expectations for how/when discipline will be administered.
I have asked, or plan to ask my provider questions to determine how he/she deal with stress.
* The following are things I will pay attention to after my child is left alone with the caregiver. By checking each box, I am indicating I have read the statements below.
If my child is upset about being left alone with the caregiver, I will ask why. It may be they miss you, but it is always a good idea to discuss your child’s feelings and comfort level with the caregiver.
I will be empowered to have a discussion with my child’s caregiver if I have any concerns.
Bruising on a non-mobile infant or bruising on a child ages 4 or young on the neck, ears or torso is a cause for concern and should be medically evaluated. For more information visit https://faceitabuse.org/ten4rule/.

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