Volunteer Clearance Form
This form must be submitted each school year.
Dear School Volunteer:

Thank you for your interest in volunteering at our school. The Pleasanton Unified School District has a screening process for all who wish to volunteer their services at one of our schools. This includes field trips, classroom and office support, library support, and any ongoing support for student activities at a school site. The purpose of this screening is to ensure that no one working with our children has a record of sexual misconduct, thus providing a safe and positive environment for our students.

The Pleasanton Police Department has agreed to provide this confidential information to the District. To complete the screening process, which could take up to two weeks, we ask you to provide the information below and return it to your school secretary in advance of any event. The information is considered highly confidential, and will only be seen by the school secretary, Human Resources, and the Pleasanton Police Department. The attached form will be kept on file at the school site.

If you wish to reimburse the District for the cost ($6.00) of this processing, please include a donation with the form below. Thank you for your understanding of our desire to keep our school safe for students.

Reminder: In order to ensure safety and minimize distractions to the learning environment,please do not bring infants or non school-age children to school with you when you are volunteering in the classroom. Volunteers are asked to make arrangement for off-campus childcare. Thank you.

Parent first name *
Your answer
Parent last name *
Your answer
Date of Birth (of parent volunteer) *
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Gender *
California driver's license or California I.D. number *
Your answer
Phone number *
Please include area code first (xxx) xxx-xxxx
Your answer
School sites where you volunteer *
Please check any sites that you have children at or will be on-site volunteering.
Required
Signature *
By typing my name I authorize the Pleasanton Unified School District to submit this information to the Pleasanton Police Department to complete the volunteer screening process.
Your answer
Today's date *
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Confidentiality Statement
I understand that in the course of my volunteer association with Pleasanton Unified School District, I share the responsibility of maintaining student, employee and District confidentiality as to any information, whether written, verbal or by actions observed, which I may have available to me. I further understand that in the course and scope of my volunteer status, I am not to discuss academic, social or other confidential information regarding students or school employees with anyone, including the parents of any student. Any breach of confidentiality will be carefully reviewed by Pleasanton Unified School District and, if substantiated, may result in the termination of my volunteer involvement with the school district.
Signature *
By typing your name you understand that you are agreeing with the Confidentiality Statement above.
Your answer
Today's Date *
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DD
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YYYY
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