Free background check form 22Free background check form 22
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Volunteer Participation Request & Background Check Form
Prospective volunteers will receive consideration without
discrimination because of race, creed, color, sex, age,
national origin or disability.

Today's Date:

Volunteer Personal Information
Legal Name (First, Middle Initial, Last):
Student Name(s):

Teacher(s):

Address (City, State, Zip Code):

Home Phone:

Work Phone:

Cell Phone:

Volunteer Date of Birth:

Gender:
Male or Female

Race:
American Indian/Alaskan
Black
Multi-‐Racial

Asian/Pacific Islander
White

Activities you plan to volunteer for:
Please check ALL the activities you are expecting to volunteer for:
Field Trips

Field Days

Century Club

Classroom Volunteer

Emergency Contact Information:
Please list who we should contact in an emergency:
Name of Contact:
Relationship:

Phone:

Address:

Please list any medical information that may assist us in the event of an emergency:
Physician's name & number:

Allergies:

Current Medications:

Criminal Background History
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