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Nelson County Public Schools - Volunteer Application
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Today's Date: *
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This is a: *
I am a: *
Personal Information *
Full Legal Name: *
Last, First and Middle Initial
Maiden name/Nickname/Aliases
Date of Birth: *
MM
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DD
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Birthplace *
(state OR country if outside U.S.)
Mailing address: *
City: *
State *
Zip Code *
Email:
Phone #: *
Languages Spoken:
Other than English
Special Skills
Employer
Names of child(ren)/student(s)
Emergency Contact Information
Name
Emergency Contact Information
Phone #
Volunteer Interests and Activities: *
School(s) where I wish to volunteer:  Check all that apply.
I plan to volunteer:
Check all that apply
Clear selection
Volunteer activities
(ex:  field trip chaperone, math help, tutoring, etc.)
Do you require any accommodations?
Check all that apply.
Clear selection
If "yes", what is the accommodation?
Waiver
All information in this application is accurate to the best of my knowledge.  I have received and thoroughly read the Nelson County Public Schools Volunteer Handbook.  I understand the information in the handbook and I agree to comply with the guidelines set forth in the handbook.  As a condition of being permitted to volunteer for Nelson County Public Schools, I freely accept and voluntarily assume the risks of personal injury or property damage that may result from my volunteer activities.  I hereby agree to waive any and all claims arising out of any such injury or damage.
Applicant Signature: *
Date of application
MM
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DD
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