Volunteer Application (Version 2)

School Year*

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Email*

example@example.com

Are you interested in volunteering at Bridport Central School?*

YesNo

Are you interested in volunteering at Cornwall Elementary School?*

YesNo

Are you interested in volunteering at Mary Hogan School?*

YesNo

Are you interested in volunteering at Ripton Elementary School?*

YesNo

Are you interested in volunteering at Salisbury Community School?*

YesNo

Are you interested in volunteering at Shoreham Elementary School?*

YesNo

Are you interested in volunteering at Weybridge Elementary School?*

YesNo

Are you interested in volunteering at Middlebury Union Middle School?*

YesNo

Are you interested in volunteering at Middlebury Union High School?*

YesNo

Please indicate the type(s) of service(s) you wish to volunteer. (Check all that apply)*

Note: Vermont State Law requires applicable background checks to be completed for all employees, volunteers, and contractors.

An online Vermont criminal record check screening through the Vermont Criminal Information Center (VCIC) and a check of the Agency of Human Services registries will be performed on all approved volunteers. This check is completed each school year in which a volunteer registers. Additionally, all volunteers who will have unsupervised time with students (e.g chaperones, student mentors, field trip drivers, etc) are required to undergo an FBI fingerprint supported background check.

At the time of fingerprinting, a fee of $35 will be due to the Addison County Sheriff Department. Upon proof of payment, the school in which the volunteer services are being provided will reimburse the volunteer for the associated fees.

Volunteer Statement Affirming Understanding

I understand that information regarding students, families, staff and the organization may be confidential in nature and that as a volunteer for the ACSD, I will:

Respect the confidential nature of any verbal or written communication I receive and keep personal information confidential at school and after I leave the school building.
Be discreet in any verbal communication by not discussing students, staff, or families in front of others.

Immediately report directly to the principal or site administrator any information disclosed to me concerning a child's safety.

Make reasonable efforts to assure that each student is protected from harassment or discrimination and I wil not harass nor discriminate against any student, staff memeber or volunteer on the basis of race, color, religion, sex, age, national or ethnic origin, political beliefs, marital status, handicapping condition, sexual orientation, or social and family background.

I also understand that relationships developed with children at school should remain at school and that for the protection of both the student, staff and volunteer, volunteers should not be left alone with a child that is out of view of school personnel or another adult volunteer.

Volunteers are also reminded that permission to communicate with a student outside the regular school day must be granted by the student’s parent/guardian, ACSD cannot and will not grant this permission.

I acknowledge I am expected to abide by all Addison Central School District policies and procedures which can be found on the ACSD website at acsdvt.org.

I further understand that by law, I am a mandatory reporter and agree to comply with all district, state and federal laws. If I have questions regarding any of the materials provided, I understand I am to contact the building principal or the ACSD Human Resources Coordinator.

Click here to view requirements for becoming a volunteer with ACSD.

Signature