Volunteer Application Applicant Information First Name: Middle Initial: Last Name: Address: City: State: Zip: Home Phone: Cell Phone: Email: Occupation: Special Skills: Volunteer Preferences Have you previously volunteered at? Yes No Do you have a school preference? Yes No (If yes, please list name of school: ) Do you wish to volunteer with a High School Band/Sports Team/Parent Organization? Yes No Do you have a child(ren) currently attending a Dysart school? Yes No Do you wish to volunteer in your child s classroom? Yes No (If yes, please list name of teacher: Grade: ) Requested Schedule What date can you begin? How many days or hours would you like to volunteer per week? Morning Afternoon Monday Tuesday Wednesday Thursday Friday Under penalty of prosecution and dismissal, I hereby certify the information presented on this application is true, accurate and complete. I understand any misrepresentation of fact, false statements, or material omissions will result in the cancellation of my volunteer status with. I also understand that district health insurance or workman s compensation insurance will not cover any incidents that may occur while I am volunteering for the district. Volunteer s Signature: :
Volunteer Coaches Application Phone: (623) 876-7875 Email: volunteer@dysart.org Prior to any coaching activities, all volunteer coaches must be interviewed by a school administrator. All volunteer coaches are required to adhere to the guidelines listed below. 1.) Volunteers must always have a certified head or assistant coach in the direct vicinity of the sporting activity. 2.) Volunteer coaches will be expected to follow all district policy and athletic department guidelines. 3.) Volunteer coaches will not be allowed to drive district vehicles. 4.) Volunteer coaches shall not administer discipline to any athlete under any circumstances. Discipline shall only be done by a certified coach employed by. 5.) District health insurance or workman s compensation will not cover volunteer coaches. The district will be protected by its general liability policy when using volunteer coaches. Volunteer coaches must complete all required documentation required by the district, including a fingerprint clearance and background check. 6.) Volunteer coaches agree to log all volunteer hours into the volunteer attendance computer program available online. 7.) Volunteer coaches must wear a district-issued name badge at all times for proper identification. 8.) Volunteer coaches understand that this is a volunteer position only. No compensation will be given. 9.) Volunteer coaches understand that this is a volunteer position only. No compensation will be given. This form must be signed by the school administrator and the volunteer coaching applicant. The completed form must be provided to the Volunteer & Compliance Specialist at the district office. I have read, understand, and will abide by all rules set forth in the Coaches Athletic Handbook and the Parent & Athlete Informed Consent & Codes of Conduct Handbook. I also agree to adhere to the guidelines for volunteering as a coach for any athletic program. Volunteer Signature Volunteer Printed Name Administrator Signature School Coaching Position / Sport Name of Head Coach
Volunteer Emergency Information Emergency Information In case of an emergency please notify: Contact Name: Phone: Contact Address: City: State: Zip: Contact Work Phone: Contact Cell Phone: Medical Information Family Physician Name: Phone: Please list any medical directives the District should give to emergency personnel in the event you are unable to do so as a result of illness or injury. Please list any medical conditions or allergies to medications: This document will be kept in a secure department. All information contained in this document will be kept strictly confidential and utilized only in case of an emergency. Please notify the Volunteer & Compliance Specialist at (623) 876-7875 or email volunteer@dysart.org if there are any changes to this information. Volunteer Signature: :
Volunteer Fingerprint Requirements All volunteers must be fingerprinted as a condition of volunteering within the school system of Dysart Unified School District. The district will assume the cost of the fingerprint checks. Individuals submitting volunteer applications shall certify whether they are awaiting trial on or have ever been convicted of or admitted in open court or pursuant to a plea agreement committing any of the following criminal offenses in Arizona or similar offenses in any jurisdiction: Sexual abuse of a minor First or second degree murder Arson Sexual exploitation of a minor Burglary in the first degree Burglary in the second or third degree Aggravated or armed robbery Robbery Child abuse Sexual conduct with a minor Molestation of a child Manslaughter Incest Kidnapping Sexual Assault Assault or aggravated assault Felony offenses contributing to delinquency of a minor Commercial sexual exploitation of a minor Exploitation of minors involving drug offenses A dangerous crime against children as defined in A.R.S. 13-604.01 Felony offense involving possession or use of marijuana, dangerous drugs, or narcotic drugs Felony offenses involving sale, distribution, or transportation of, offer to sell, transport, or distribute, or conspiracy to sell, transport or distribute marijuana or other dangerous narcotic drugs Misdemeanor offenses involving possession or use or marijuana or dangerous drugs I,, being duly sworn, do hereby certify that I have never been convicted of or admitted in open court or pursuant to a plea agreement committing, and am not now awaiting trial for committing, any of the offenses listed above in the state of Arizona or similar offenses in any other jurisdiction. Volunteer Signature (sign in presence of notary): : Subscribe, sworn to, and acknowledged before me by, this day of, 20 in Maricopa County, Arizona. My commission expires: Notary Public: *Any person making a false statement on an application submitted to the school district will be guilty of a Class 3 misdemeanor.
Fingerprint Clearance Application Click on fields below to enter information online or print and fill out form by hand. **Please turn in the completed form to the Volunteer & Compliance Specialist at the District Office.** First Name Middle I. Last Name Address City State Zip Social Security Number Driver s License No. of Birth Sex M/F Place of Birth: City/State Aliases (Other Names Known By) Height Weight Color of Eyes Color of Hair *Race Fingerprint and background checks must be renewed every five (5) years. Please bring a driver s license or other photo identification as proof of identity to the Volunteer & Compliance Specialist at the Dysart district office. Fingerprints will be taken at the district office. This application will be submitted to the Arizona Department of Public Safety. **All fingerprint fees are paid by the district** Phone: 623.876.7875 Email: volunteer@dysart.org *Code: Racial / Ethnic Designation: A Asian B Black I Native American U Unknown W Caucasian / Latino Have you ever been arrested, convicted of, admitted committing, or are you awaiting trial for any crime (excluding only minor traffic violations not involving any allegation of drug or alcohol impairment)? You must answer Yes even if the matter was later reduced, dismissed, deferred, vacated or expunged. If you answer Yes you must provide dates of the proceedings, the court where the proceedings occurred, a statement of the accusation against you and the final disposition of the case(s). Yes No (If Yes you must attach an explanation.)
Volunteer Confidentiality Agreement Volunteer Confidentiality Agreement Volunteers are required to comply with all requirements concerning handling of and exposure to confidential information and materials in the school setting. Please sign below if you agree with confidentiality requirements. I,, a volunteer of #89, have been informed of my personal responsibility to honor and protect confidential matters and documents to which I have been exposed or have access to in my official volunteer duties. Furthermore, I understand and agree that willful violation of the confidentiality of any student s school related information shall result in immediate removal from my volunteer assignment. Volunteer Signature Volunteer & Compliance Specialist 15802 North Parkview Place Surprise, AZ 85374 Phone: 623.876.7875 Email: volunteer@dysart.org
Volunteer Statement of Understanding Volunteer Statement of Understanding Please read the following statement carefully and indicate your understanding and acceptance by signing below. My agreement below constitutes authorization to check my employment history, including without limitation, criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize those persons, agencies or entities that the Dysart Unified School District #89 contacts in connection with my volunteer application to fully provide the Dysart Unified School District #89 with all information it requests. I hereby release the #89, its members, employees and agents from any claims, including without limitation, defamation, emotional distress, invasion of privacy or interference with contractual relations that I might otherwise have against the #89, its agents, officials, or against any provider of such information. I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include Board Members, administrators, other staff and members of the community. I give my consent to this disclosure. I certify that I have read this form in its entirety and that the information herein provided is true, accurate and complete. I understand that, should any statement I have made prove to be false, or misleading, it may result in the rejection of my volunteer application or in my discharge if I am volunteering. If already volunteering, I also understand that any misstatement or omission of fact on this application may result in my discharge. I understand that all documents I provide to #89 as part of my volunteer application will become property of and will not be returned. Volunteer Signature Volunteer & Compliance Specialist 15802 North Parkview Place Surprise, AZ 85374 Phone: (623) 876-7875 Email: volunteer@dysart.org
Volunteer Video Orientation & Handbook Volunteer Video Orientation & Handbook Confirmation All volunteers are required to view the volunteer orientation video and read the volunteer handbook. I,, have viewed the volunteer orientation video and have read the volunteer handbook. I have been informed of the policies and procedures listed therein and will abide by all rules and regulations set forth by the district for all volunteers. Volunteer Signature Volunteer & Compliance Specialist 15802 North Parkview Place Surprise, AZ 85374 Phone: (623) 876-7875 Email: volunteer@dysart.org