Background Check Certification

This form must be completed by the President or Secretary of the sponsoring Kiwanis club. No club  registration will be accepted without this form! Kiwanis Advisors must have a completed background check on file with the above-mentioned Kiwanis Club pursuant to the requirements of the Youth Protection Guidelines.

To: Kiwanis Administrator of the Michigan District of Key Club International

Dear Sir/Madam: 

This is to advise you that the Kiwanis Club listed below which sponsors the Key Club listed below, hereby certifies that it has authorized and appointed the person(s) listed below to attend the 73rd Annual District Service Leadership Conference in Lansing, MI at the Crowne Plaza, February 16–18, 2024 as the designated Kiwanis Advisor/Chaperone to the named Key Club. We further certify that they are fully authorized to act in the name and place of the named Kiwanis Club in all matters affecting the Key Club’s members’ conduct, discipline, and obedience to the Service Leadership Conference code of conduct. It is understood that Kiwanis Advisors/Chaperones are expected to do all in their power to see to it that Key Clubbers obey all Service Leadership Conference rules and are expected to conform to those rules themselves. 

Sincerely, 

Name
Role
Advisor(s) and/ or Chaperone(s)
List all advisors or chaperones. Add rows as needed.
Name
Kiwanis member? Yes/No
Background Check on file? Yes/No
 
MM slash DD slash YYYY
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