Fillable Volunteer Consent Form printable pdf download

Volunteer Consent Form

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THIS FORM WILL BE KEPT CONFIDENTIAL

The Rockford Public Schools, parents and volunteers have worked together to create true community schools.

Due to this partnership, our students have achieved higher and have had more success academically. In a

continued effort to keep our schools as safe as possible, we are asking volunteer parents and community members

to submit to criminal background checks. Through the Volunteer Consent Form any response will be kept

confidential with the school Security Department, Principal of the school building, and Superintendent (or

designee). Thank you for your understanding with this matter and for all you give to our schools, community

and children. You need only submit this form once per school year.

VOLUNTEER CONSENT FORM

ONE NAME PER FORM COVERS ALL STUDENTS IN ALL BUILDINGS

(Check one box, please)

Parent

Guardian

Other_____________________

Grandparent

PLEASE PRINT: MUST HAVE CONTACT PHONE #_______________________________

Last Name:_____________________First Name:___________________Middle Initial:_______

Race:_____________________

Sex:_______

Month of Birth:_________________ Day of Birth:_________________Year of Birth:_________

MI Driver License Number:_________________________

Other Last Name:_____________________ Other First Name:____________________ Middle Initial:_________

MUST COMPLETE THE BUILDING INFORMATION BELOW

LIST ALL BUILDINGS YOU WILL BE VOLUNTEERING IN:________________________________

_____________________________________________________________________________________

I understand the Central Records Division of the Michigan State Police, Lansing, Michigan, requires the

above information. I authorize Rockford Public Schools to utilize the above information for the sole

purpose of obtaining a conviction-only criminal history file search.

VOLUNTEER’S SIGNATURE:

DATE:

4100 Kroes, Rockford, Michigan 49341

Phone: 616-863-6034 -- Fax: 616-866-7112

Volunteer Consent Form

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