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 *
First name *
Date of Birth *
Physical Address *
Mailing Address
Home Phone
Cell Phone
Student's Name(s) *
Relationship to student *
Have you ever received a protective order? *
If yes, explain
Have you ever been convicted of a misdemeanor? *
If yes, explain,including relevant dates.
Have you ever been convicted of a felony? *
If yes, explain, including relevant dates.
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. *
Signature *
Date *
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