The Nature Connection: Volunteer Application

Because TNC operates within the school district, this application must be completed annually and approved by the school board prior to volunteer participation during TNC programs.

Today's Date *

Month Day Year

Name: *

Birthdate: *

Month Day Year

Home Phone Number: *

Work Phone Number: *

Home Address (street, city, state, zip): *

List two (2) character references other than family members. Include their phone numbers and email addresses. *

Have you ever been convicted of: *

a felony any offense involving moral turpitude a misdemeanor other than a minor traffic offense received probation or entered a plea of "no contest" (nolo contendere) a crime against a child None of the above: NONE

If you checked any box other than NONE OF THE ABOVE, please explain: *

Do you have specific skills you'd like to share? *

Do you have any physical limitations of which we should be aware? *

If in the course of your volunteer work, you receive information regarding suspected child abuse or neglect, the following procedure must be followed: 1) Report any case of suspected child abuse or neglect to immediate supervisor. 2) The supervisor will immediately report all cases to Delta County Social Services. 3) At no time are you to investigate the suspected abuse or neglect. This is the responsibility of Delta County Social Services.

By checking this box, I consent to the above

Delta County School District 50J will conduct a reference check including a criminal background check. By submitting this application, you certify that the facts contained herein are true and complete to the best of your knowledge, and understand that if approved for volunteer work, falsified statements on this application shall be grounds for revocation of permission to volunteer in the schools. *

By checking this box, I consent to the above

TNC/DCSD's Signature and Date:

DCSD Volunteer Application