Member DMG + American Association of Christian Therapists

Records Check

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You may send a records check that you have done yourself or fill out the form and we will check records for you.  We have not had an occurance with AACT members.  Our goal in setting up this check is to keep AACT free from any who may choose to abuse their clients.
You may request the check and have the following form sent to us or submit an additional $50.00 and AACT will submit the form for you.  You must submit this form (or one that you have had run) before we will issue your certification or license.  Beginning January 2007 each member will have to submit a records check every two years to remain certified or licensed by the AACT.







I hereby request Choice Point/Volunteer Select to release any information which pertains to any record of convictions contained in its files or in any criminal files maintained on me whether local, state, or national.  I hereby release Choice Point/Volunteer Select from any and all liability resulting from such disclosure.



___________________________             Record Check Sent To:

Signature                                                  Dayspring Ministries


                                                                   P.O. Box 3634

___________________________             Brookhaven, MS  39603

Print Name                                                  Attn: Dr. Gary Barkman




Print Maiden Name (If Appoicable)




Print All Aliases




Date of Birth                                                                         




Place of Birth



Social Security Number




Today’s Date




The above signed does authorize the release of any of his/hers records to Dayspring Ministries International, P.O. Box 3634, Brookhaven, Mississippi  39603.