LTSD Volunteer Affidavit 19-20
Please refer to Policy 9180 for detailed information regarding school volunteers. All district policies and regulations can be found at
Volunteer Last Name
Volunteer First Name
Volunteer Street Address
Primary Phone Number
What school(s) will you be volunteering in? Please check all that apply.
AES (Summer Only)
Thank you for your interest in serving as a school or district volunteer. For the protection of our students and staff, volunteers must complete a Volunteer Affidavit each school year. I agree to acquire, read and follow and guidelines included within this affidavit.
1. I, named above, as a Lumberton Township School District Volunteer, agree to keep strictly confidential any information to which I may have access concerning any and all students, thereby meeting the requirements of the Family Education Rights and Privacy Act.
2. I understand that as a district Volunteer, my contact with students is only to take place while at school and/or during school-related activities. While I am acting as a school volunteer, any attempts to communicate or make contact with students outside of school are strictly prohibited.
3. Equity Policy – Prohibiting Discrimination
a. It is the policy of the Lumberton Township Board of Education to offer students the opportunity to participate in appropriate programs, services and activities without regard to race, color, religion, sex, age, national or ethnic origin, political belief, marital status, parenthood, pregnancy, disability, sexual orientation, or social and family background.
b. Students, while they are in school or participating in school-related activities, are entitled to an environment free of discrimination and/or harassment by other students or adult employees or volunteers. Students should not be subject to, nor should they subject others to:
i. Slurs or innuendoes about any characteristics listed in “a” above;
ii. Any activity or talk related to “a” above that creates an offensive educational environment or unreasonably interferes with the individual’s school performance or participation in educational opportunities;
iii. Sexual advances, requests for sexual favors, or physical conduct of a sexual nature.
c. All employees and volunteers are expected to work with other district employees, to teach students, and to supervise or to be supervised in their work by other employees without regard for race, color, religion, sex, national ethnic origin, age, marital status, or disability.
4. Drug Free Workplace
a. The Lumberton Township School District complies with the Drug Free Workplace Act of 1988 to maintain a drug-free workplace. The “workplace” is defined by U. S. Code and Code of Federal regulations – and is amended from time to time at the discretion of those organizations.
b. Each employee and the public is hereby notified by this policy that the unlawful manufacture, dispensing, possession, distribution, or use of a controlled substance or alcohol is strictly prohibited at any and all work sites or work related functions or as a part of any school activity, or any function held on the school board property.
5. I am aware that, for the protection of students, the Lumberton Township School District may conduct criminal background checks on all volunteers. I hereby approve of such a check on my background and agree to provide my Social Security number, if requested by the district.
Have you ever been convicted of, pleaded guilty to, or had adjudication for a crime which qualifies you as a Tier 2 or Tier 3 sex offender?
Have you ever been convicted of a crime or a disorderly persons offense where the victim was person under the age of 18?
My initials below indicate that I agree to adhere to statements 1-5 and that the information provided on the two questions above are correct and truthful.
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