I, having made application for membership with the Derry Township V.F.D. Co.#1 of Bradenville, understand that the D.T.V.F.D. desires to obtain information concerning my background, education and character in order to better ascertain my qualification for such membership.

I hereby authorize the Derry Township V.F.D. and/or their agent(s) on behalf of the Township of Derry to investigate and ascertain any and all information concerning my background and character which may be pertinent to my qualification for membership. I understand that the information may be obtained from any person, document, or other source within or outside the Commonwealth of Pennsylvania.

I hereby release all persons and the Township of Derry from any liability which might otherwise result from the release of said information to any authorized member of the Township of Derry and/or their agent(s). In consideration of this release, The Township of Derry and their agent(s) shall regard all information obtained as confidential.

I understand the same shall not be released to any individual or organization, including myself. I agree that the Township of Derry may admit this information into evidence in order to defend administrative or court proceeding which is initiated on my behalf.

BY CLICKING SUBMIT, YOU AGREE TO THE SAID TERMS OF THE WAIVER:::