SY2019 CHS Volunteer Application Form
In Accordance with AR1240, the Matanuska-Susitna Borough School District reserves the right to run your name through the State of Alaska Sex Offender Database. All volunteers must provide their legal name and aliases on this form and agree to be checked in the Sex Offender database, prior to beginning as an active volunteer, annually. By signing below, I understand that all student information to which I have access as a school volunteer is confidential. Such information might include health information in written, oral, or electronic form. I agree not to discuss any confidential information, including but not limited to any descriptions of situations as well as names of students. I also understand that even when I am no longer a volunteer for MSBSD, confidential information I have learned as a volunteer must continue to be kept confidential.
Last Name *
Your answer
First name *
Your answer
Date of Birth *
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Aliases
Your answer
Physical Address *
Your answer
Mailing Address
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Student's Name(s) *
Your answer
Relationship to student *
Your answer
Have you ever received a protective order? *
If yes, explain
Your answer
Have you ever been convicted of a misdemeanor? *
If yes, explain,including relevant dates.
Your answer
Have you ever been convicted of a felony? *
If yes, explain, including relevant dates.
Your answer
I shall defend, idemnify, and hold the Matanuska-Susitna Borough School District, its officers, employees, and agents harmless against any and all liability, loss, expense (including reasonable attorney's fees), or claims for injury or damage arising out of or connected with volunteering at Colony High School. *
Required
Signature *
Your answer
Date *
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YYYY
Submit
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