Trillium Academy Volunteer Sign up Form

Trillium Academy Volunteer Sign up Form
Thanks so much for volunteering with us at Trillium Academy! The Volunteer Handbook can be found here.

ALL VOLUNTEERS: Please complete the questions below to initiate the background check process.

Those wishing to drive for Field Trips complete this form or provide to our business office:

1) copy of your current driver's license;

2) copy of your current Proof of Insurance card;

3) make, model, and license plate number of vehicle(s) being used in student transport must be provided to the business office.

If you have any questions please contact volunteers@trilliumacademy.org.
Full Name

First NameMiddle NameLast Name
E-mail
example@example.com
Phone Number
Emergency Contact Name

First NameLast Name
Phone Number for Emergency Contact
Please enter a valid phone number.
Your Student's Name

First NameLast Name
Your Student's Grade Level
Your Student's Name

First NameLast Name
Your Student's Grade Level
Preferred Area to Volunteer:

Garden DevelopmentCommunicationDecoratingEvent PlanningGrant WritingHandy-personSoftwareStudent SupportTeacher TrainingVolunteer CoordinatorWritingFacilities SupportMakers Space Program SupportField TripsAfter School SupportLunch for StaffultyStaffulty AppreciationLanguage Arts Program SupportGeneral Classroom SupportClerical SupportMusic Program SupportBuilding ProjectsParent EducationHumanities Program SupportAdmissions EventsTutoringArts Program SupportStudent Services SupportFamily Social EventNew Family WelcomesScience Program SupportFundraisingGuest SpeakerGraduationBoard CommitteeTechnology Support (website, etc.)Academic events (curriculum nights, conferences, etc.)Math Program SupportOther
Any special message you need us to know or other volunteer area you're interested in supporting
Volunteer Release of Liability & Confidentiality Agreement Release

I, the undersigned, hereby release and agree to hold harmless Trillium Academy, its officers, directors, and employees of any and all liability that could possibly be incurred as a result of my negligence, intentional or unintentional, during the commission of my responsibilities as a volunteer for Trillium Academy.

I further release and hold harmless Trillium Academy, its officers, directors, and employees of all liability with regard to any physical or emotional harm that I may sustain during the time I volunteer at the School, or as a result of my participation as a volunteer, or in any other activity sanctioned by Trillium Academy.

Additionally I agree to the following:

• My role is as a volunteer, and, as such, I will receive no financial reimbursement for services rendered.

• I have reviewed, understand, and agree to abide by the Volunteer Handbook.

• I will submit to a background check to determine that I do not have a criminal history that would render me unable to work with or around children.

• I will bring to the attention of Trillium Academy administration any information or questions that arise of a legal or mandatory reporting nature.

• I recognize that any and all information shared with me or observed as part of my duties as a volunteer is confidential and shall not be divulged to unauthorized individuals, agencies, or organizations.

• I will not copy, transcribe, record, or memorize confidential Trillium Academy information in any manner, nor disclose or use such information for any purpose other than for the limited purpose of providing the assigned services at the Trillium Academy.

THIS AGREEMENT shall be governed by and construed in accordance with the laws of the State of Washington. I have had the opportunity to read and understand the release and acknowledge that by signing the document, I am waiving certain legal rights in the event of injury.

BY SIGNING BELOW, I accept and agree to the terms contained above.
Signature for Volunteer Release of Liability & Confidentiality Agreement

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Date

MonthDayYear
Date
Washington State Patrol Check and Declaration

In accordance with RCW 43.43.830, applicants and prospective volunteers are required to complete this disclosure form. Trillium Academy conducts routine Washington State Patrol background checks on all volunteers. For the safety of our children, all volunteers must complete this form and be cleared through the Washington State Patrol Criminal History (WATCH) program. By signing this application, you grant Trillium Academy permission to conduct the background check, attest to the accuracy of the information provided, and hold Trillium Academy harmless for the results. If you do not sign below, we cannot process your request and you will not be able to volunteer. WSP results are available upon request.
1. Have you ever been convicted of ANY crime? (Convicted includes ALL instances in which a finding of guilty, a plea of guilty or nolo contendere, an Alford plea, or stipulation to the facts is the basis of conviction and/or all proceedings in which prosecution has been deferred or a sentence has been suspended or deferred).

YesNo
2. Have you ever been convicted of a crime relating to DUI or drugs?

YesNo
3. Have you ever been convicted of a crime relating to abuse, neglect, sexual abuse, exploitation, or physical abuse?

YesNo
4. Have you ever been convicted of a crime relating to financial exploitation, including extortion, theft, robbery, or forgery?

YesNo
5. Do you currently have any outstanding criminal charges or warrants against you in WA or in any other state or country?

YesNo
6. Have you ever been convicted of domestic violence or assault?

YesNo
7. Have you ever had findings made against you for domestic violence, abuse, sexual abuse, neglect, exploitation or financial exploitation of a child or a vulnerable adult in any civil adjudicative proceeding? (A civil adjudicative proceeding includes a judicial or administrative proceeding as well as findings by the Department of Social and Health Services or the Department of Health that you have not administratively challenged or appealed.)

YesNo
FemaleMaleOther
Race:
Birthdate (Month/Date/Year - 00/00/0000)
Signature allowing Washington State Patrol background check.

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