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VOLUNTEER BACKGROUND CHECK
The Bath Community Schools recognizes that volunteers perform a vital role in supporting and promoting its educational and extracurricular activities for the benefit of students, staff and the public welfare. In order to take steps necessary to ensure safety for all students and staff, building volunteers are asked to have a Limited Criminal History background check on file each school year. This report will be kept on file in the superintendent’s office.

It is the responsibility of the volunteer to work with Local Law Enforcement to clear any items listed on a background check. It shall be at the discretion of the Superintendent or other designated Administrators to limit the type of volunteering based on information listed on a background check in conjunction with applicable Local and State Laws.

I hereby acknowledge and agree to the following:

I have offered my services as a volunteer to help the Bath Community Schools.

I agree to abide by all relevant Board policies and administrative guidelines while serving as a volunteer for the District. I understand that, although I am covered under the District’s liability Insurance policy, I am not covered by its health insurance policy; I am not eligible for worker’s compensation. Should I become ill or suffer an accident while doing volunteer work for the District, 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 district or entitled to any benefits provided to employees. I further release the Board of Education, Individual Board members, its employees and agents from any and all liability for any damages, which may result to me as a consequence of my volunteer services.

At times, I may have care, control or custody of students, other than my own child, out of the direct supervision of a teacher or other school employees and I acknowledge that I am required to demonstrate appropriate decorum, judgment and dress in my capacity as a volunteer.

To obtain a Limited Criminal History background check, please complete and submit this form. The school may request a copy of your driver’s license or other form of identification to ensure accuracy.

* Please note that if completing the form less than two weeks prior to the event, your form may not be approved and no exceptions will be made unless approved by superintendent .
Potential Volunteer Information Form
Date to provide service:
Your answer
Full Printed Name (Last Name, First Name, Middle Name): *
Your answer
Maiden name or other name(s) previously used (indicate N/Aif doesn't apply): *
Your answer
Phone Number *
Your answer
Address *
Your answer
Email Address *
Your answer
DOB: *
MM
/
DD
/
YYYY
Sex: *
Eye Color *
Your answer
Hair *
Your answer
Height *
Your answer
Race *
Do you have a student that attends Bath Community Schools? *
Relation to student (i.e. child, grandchild, family friend & indicate N/A if doesn't apply) : *
Your answer
Have you volunteered at Bath Community Schools before? *
Have you ever pled guilty, or been convicted of a felony in a state or federal court? *
Date and state offense /conviction occurred(indicate N/Aif doesn't apply): *
Your answer
If yes, provide a detailed description of the conviction:
Your answer
Have you ever pled guilty, or been convicted of a misdemeanor in a state or federal court? *
Date and state offense/misdemeanor occured (indicate N/Aif doesn't apply): *
Your answer
If yes, provide a detailed description of the conviction:
Your answer
Are you the subject of a current criminal investigation or have pending charges against you? *
Date and state the investigation is ongoing (indicate N/Aif doesn't apply): *
Your answer
If yes, provide a detailed description of the investigation or pending charges (indicate N/Aif doesn't apply) :
Your answer
Bath Community Schools reserves the right to "approve" or "deny" any volunteer service upon review of the background check returned through ICHAT. The determination will be based upon the individual's fitness to have responsibility for the safety and well-being of children. Providing false information, or information contradicting the background check information, is grounds for immediate volunteer denial. By submitting this form you acknowledge your statements are to be true and give full consent to complete a name based background check through ICHAT. *
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