Volunteer Participation Request For Greensburg printable pdf download

Date of Application: _____________

School: ________________________

GREENSBURG COMMUNITY SCHOOLS

VOLUNTEER PARTICIPATION REQUEST FORM

__________________________________________________________________________________

NAME: ___________________________________________________________________________________________________

(Print)

Last

(Maiden Name)

First

Middle

ADDRESS:

_________________________ CITY: ____________________ ZIP CODE: _________ COUNTY: ______________

TELEPHONE: ______________________ _____________________ DATE OF BIRTH: __________ RACE: ______ SEX: ______

Home

Other

⁭ Parent/Guardian of a GCS child

⁭ College Student

Please indicate your status:

⁭ Corporate Volunteer

⁭ Community Volunteer

_________________________

_______________________________

Company represented

Organization represented

⁭ Other (specify) ___________________________________

⁭ Academic Tutor

⁭ Classroom

⁭ Reading Aide

Please indicate volunteer preference:

⁭ Office Aide

⁭ Outdoor Education

⁭ Room Parent

⁭ PTO

⁭ General School

⁭ Volunteer Coach

⁭ Club Sponsor

⁭ Chaperone

⁭ Intern/Student Teacher

⁭ Other ______________________________________________

Read carefully before signing:

I certify that the information contained in this application as submitted is true, complete, and accurate to the best of my knowledge. I

understand that falsification of information will be cause for disqualification. I also understand that I will be required to undergo a

Limited Criminal History Check through the Indiana State Police repository and the National Sex Offenders Registry as a condition for

consideration for volunteer service. The status of the Limited Criminal History Check and/or the National Sex Offenders Registry could

affect the school’s approval of the request to volunteer. A felony conviction, a history of violent offenses or sexual oriented crimes will

prohibit any volunteer participation. Please note: If the Limited Criminal History Check shows a felony arrest or conviction, and the

status of this arrest or conviction is inaccurate or has changed, it will be the responsibility of the applicant to provide court

documentation indicating the status change in the arrest or conviction.

Applicant signature: ___________________________________ Date: __________________________

VOLUNTEER CONSENT AND RELEASE STATEMENT

If accepted as a volunteer, I hereby consent, understand and agree to abide by the policies, rules and regulations of Greensburg

Community Schools, and to comply with and abide by such other rules, regulations, and directions of the Principal, Administrator, or

other responsible GCS employee. I understand that Greensburg Community Schools is not responsible for any injury to my person or

damage to my property while I am acting as a volunteer. Furthermore, I hereby waive, release, covenant not to sue, and otherwise hold

GCS, its officers and employees harmless from and against any and all claims or liabilities of any nature whatsoever that might arise as a

result of my work as a volunteer for Greensburg Community Schools.

Applicant signature: ___________________________________ Date: ____________________________

______________________________________________________________________________________________________________

INTERNAL USE ONLY:

Approved to volunteer: Yes ⁭ No⁭

Building Administrator Signature: __________________________ Date: _______________

Page 1 of 2

Volunteer Participation Request For Greensburg

Related Articles

Related forms

Related Categories