RBBCSC Volunteer Release Form
Date of Birth
Social Security # or Driver's License #
Child's Name #1
Child #1 Grade
Child's Name #2
Child #2 Grade
Child's Name #3
Child #3 Grade
Relationship to Student(s)
If other, please specify.
School(s) at which you plan to volunteer
Please select the following ways you plan to volunteer
Regular Classroom Volunteer
Disclaimers and Affirmation
I agree to abide by all relevant Richland-Bean Blossom Community School Corporation (RBBCSC) policies and administrative guidelines while on duty for the Corporation. I understand that although I am covered under the RBBCSC’s liability insurance policy, I am not covered by its health insurance policy nor am I eligible for workers’ compensation. Should I become ill or suffer an accident while doing volunteer work for the Corporation, I agree that I shall be responsible for any and all hospital and medical charges that may accrue.
I understand further that as a volunteer, I am not in any manner considered an employee of the RBBCSC or entitled to any benefits provided to employees. I further release the Board and RBBCSC from any and all liability for any damages, whatever their nature, which may result as a consequence of my volunteer services.
For the protection of the children in the school, RBBCSC is required by law to inquire of its staff members whether or not they have ever been convicted of a crime related to children. We would appreciate your cooperation by indicating that you have never been convicted of any of the following offensives: aggravated murder, murder, voluntary manslaughter, involuntary manslaughter, felonious assault, aggravated assault, assault, aggravated menacing, abuse or neglect of a child, kidnapping, abduction, child stealing, criminal child enticement, rape, sexual battery, corruption of a minor, gross sexual imposition, importuning, voyeurism, public indecency, felonious, sexual penetration, compelling prostitution, promoting prostitution, procuring prostitution, disseminating matter harmful to juveniles, pandering obscenity, pandering obscenity involving a minor, pandering sexually-oriented matter involving a minor, illegal use of a minor in nudity-oriented material or performance, endangering children, contributing to the delinquency of children, carrying concealed weapons, improperly discharging a firearm at or into a school or objects in or adulterating food or confection.
I understand that to protect our students, by clicking "Submit" below, will allow the corporation to complete a criminal history check. In addition I will provide my birth date for such purposes.
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This form was created inside of Richland-Bean Blossom Community School Corporation.