FAIR CREDIT REPORTING ACT DISCLOSURE

In conjunction with my request to stay temporarily as a guest at the Ronald McDonald House® in Tucson, Arizona , I understand that Ronald McDonald House Charities® of Southern Arizona (RMHCSA) intends to hire SELECTiON.COM® to conduct a criminal background check and/or, if applicable, to obtain Consumer Reports and / or Investigative Consumer Reports (hereinafter called Reports) about me as defined in the federal Fair Credit Reporting Act (FCRA). These Reports may include information concerning my criminal record, if any.

I understand that RMHCSA may rely on any or all of the above referenced information in determining whether to allow me to stay temporarily at the Ronald McDonald House as a guest. If RMHCSA contemplates making an adverse decision that will affect me based, in whole or in part, upon a Report obtained from SELECTiON.COM®, RMHCSA will provide me with a copy of the Report and a written summary of my Consumer Rights under the FCRA, if applicable, before RMHCSA finalizes that decision.

I have read the above disclosure, and I hereby authorize RMHCSA, SELECTiON.COM® or its / their authorized agents to obtain the above referenced information about me. I also authorize all agencies, bureaus, employers, information service organizations and individuals to provide any of the above referenced knowledge or information they have concerning me. If I am permitted to stay temporarily at the Ronald McDonald House, this authorization shall remain on file and shall serve as an ongoing authorization for RMHCSA to obtain other Reports about me from SELECTiON.COM® at any time during my stay at the Ronald McDonald House. A photocopy or facsimile of this authorization shall be as valid as the original.