Volunteer Application

We appreciate your desire to be a volunteer in the Dade County Schools (DCS). Because the safety of our children is of utmost importance, this information form must be submitted and processed prior to volunteering in any school or department. Please understand that volunteering on school campuses and district property and events is a privilege and not a right. The district reserves the right to revoke this privilege at its discretion for any reason, including concerns regarding disruption or threats to the safety of the school, staff, or students. This form and all materials submitted become property of DCS. Before clicking Submit, please check the box to verify that you have read the agreement then sign and date.

School volunteers are mandated reporters of child abuse in Georgia and therefore must complete a Child Abuse Reporting Protocol training prior to beginning any volunteer work.

At what level do you wish to volunteer?*

Level 1 - Volunteers who do not work in direct contact with students nor participate in overnight trips. Examples include, but are not limited to, volunteers assisting school personnel, working in concession stands, clean-up days, etc...Level 2 - Volunteers who have direct contact with students. At a minimum, all Level 2 volunteers will be required to get a criminal background check.

Please specify your reason for applying to volunteer. (PTO officer, Band/Chorus overnight event, etc.)

Full Name*

First NameMiddle NameLast Name

Date of Birth*

Date

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Please name a person to contact in case of an emergency:

Emergency Contact Name*

First NameLast Name

Emergency Contact Relationship*

Emergency Contact Phone Number*

Please enter a valid phone number.

Please answer the questions below. If any answer is yes, please include an explanation in the area provided.

Question 1: Have you ever been found guilty, entered a plea of nolo contendere, been granted first offender treatment without adjudication of guilt, been placed under a court order whereby an adjudication or sentence was otherwise withheld for a felony, or is any charge currently pending against you of the same nature?*

YesNo

If you answered Yes to Question 1, please explain.

Question 2: Have you ever been found guilty, entered a plea of nolo contendere, been granted first offender treatment without adjudication of guilt, been placed under a court order whereby an adjudication or sentence was otherwise withheld for any misdemeanor of a high and aggravated nature, or is any charge currently pending against you of the same nature? Note: A third DUI conviction raises the offense to a high and aggravated nature.*

YesNo

If you answered Yes to Question 2, please explain.

Question 3: Have you ever been accused of, charged with, and/or investigated for allegations of sexual offenses?*

YesNo

If you answered Yes to Question 3, please explain.

Question 4: Have you ever been accused of, charged with, and/or investigated for a crime of child abuse or physical abuse?*

YesNo

If you answered Yes to Question 4, please explain.

Read the following presentation which shows your responsibilities as a volunteer to be a mandated reporter...

I certify that the information contained in this form is true and accurate to the best of my knowledge. I understand that misrepresentation or omission of information will be cause for rejection of my request to volunteer in DCS.

I agree to serve on an as needed basis without expectations of compensation or benefits and waive any rights accorded DCS employees in accordance with the School District's manual and statutory obligations.

I acknowledge that all activities involve the risk of injury and/or damage to personal property. I agree, in my volunteer service, that I will hold harmless DCS District, Members of the DCS Board of Education, its past, present and future officers, attorneys, employees, predecessors and successors in interest, and assigns, from any and all liability whatsoever for any injury, condition, or other problem associated with my volunteer work with DCS, except for actions by DCS officials performed with actual malice. As provided herein, I hereby agree for myself, my child(ren), my heirs, executors and administrators, to waive and release any and all injuries or losses suffered by myself during volunteer activities. I agree to assume all financial responsibility for the medical expense incurred, as a result of my participation in said DCS volunteer efforts.

I understand that I must provide a valid Georgia driver's license or state ID. I understand that DCS reserves the right to run a crimminal background check at its discretion as a condition of eligibility to begin or continue volunteer services. I understand that my refusal to provide the required information for this check may be grounds for dismissal or ineligibility for volunteer services.

Acknowledgment*

I have viewed and understand the Volunteer PowerPoint outlining my responsibilities as a mandated reporter under O.C.G.A. 19-7-5.

Signature

Date*

Date