GVA Volunteer Screening Form

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Please complete this form to request approval for on-campus volunteer opportunities.

A copy of your ID and a current picture is also required and must be submitted at the school/site where you will be volunteering.

Complete this form prior to September 30th to receive an on-campus volunteer name tag for the current school year.

First Name *

Last Name *

Telephone Number *

Birth Date

YYYY

Street Address *

City *

Zip Code *

Emergency Contact name *

Emergency Contact number *

Comments / questions / additional information you'd like to provide, such as health concerns, limitations, or issues we should be aware of:

Have you ever been charged with any offense involving the sexual molestation, physical or sexual abuse, or rape of a child? * *

Yes

Have you ever been convicted of a criminal offense other than minor traffic offenses? (For purposes of this form, the term “convicted” includes and means conviction by a court or by a jury, and shall also include a plea of “no contest” or the imposition of a deferred sentence). * *

Yes

If you answered Yes to either of the two questions above, please explain briefly below.

Confidentiality Agreement *

This Volunteer Non-Disclosure agreement (the “Agreement”) is made between Global Village Academy Aurora (“Company”) and _________________ (“Volunteer”) and is effective immediately. Volunteer is performing services for the Company without promise, expectation or receipt of compensation for services rendered, and in the process may be exposed to Confidential Information (as defined below). The Agreement is intended to prevent the unauthorized disclosure of Confidential Information.1. Confidential Information: “Confidential Information” is proprietary information relating to Company’s business including but not limited to: student data, student names, business and financial records, intellectual property, security measures, or any other proprietary business information that, if disclosed, could affect the business of the Company. 2. Non-Disclosure: Without Company’s prior written consent, Volunteer will not: (a) disclose Confidential Information to any third party; (b) make or permit to be made copies or other reproductions of Confidential Information; or (c) make any commercial use of Confidential Information. 3. Return of Confidential Materials: Volunteer shall immediately return all original materials provided by Company and any copies, notes or other documents in Volunteer’s possession pertaining to Confidential Information. 4. Term: This Agreement and Volunteer’s duty to hold Confidential Information in confidence shall remain in effect indefinitely. 5. Notice of Immunity from Liability: An individual shall not be held criminally or civilly liable under any federal or state trade secret law for the disclosure of a trade secret that is made (i) in confidence to a federal, state, or local government official, either directly or indirectly, or to an attorney; and (ii) solely for the purpose of reporting or investigating a suspected violation of law. 6. General Provisions: (a) Severability. If a court finds any provision of this Agreement invalid or unenforceable, the remainder of this Agreement shall be interpreted so as best to affect the intent of the parties. (b) Integration. This Agreement expresses the complete understanding of the parties with respect to the subject matter and supersedes all prior proposals, agreements, representations and understandings. This Agreement may not be amended except in a writing signed by both parties. (c) Waiver. The failure to exercise any right provided in this Agreement shall not be a waiver of prior or subsequent rights.

I agree

I do not agree

GVA Agreement *

I agree that I understand my responsibilities as a Parent Volunteer at GVA. My primary goal is to provide a safe and nurturing environment for all students. I agree to work as part of the GVA community with staff and teachers, and uphold the expectations of GVA.

I agree

I disagree

Disclosure

In connection with this request, I authorize all law enforcement agencies, city, state, county and federal courts, Aurora city government, military services and persons to release information they may have about me to the person or company with which this form has been filed or their agent, Verified Volunteers. This releases the aforesaid parties from any liability and responsibility for collecting the above information. I understand that these files may contain negative information about my background, mode of living, character, and personal reputation. This authorization, in original or copy form, shall be valid for this and any future reports or updates that may be requested. I understand that, as a volunteer, I am not covered by Aurora Public Schools workers’ compensation insurance for any injuries I sustain while volunteering.

I have read and understand the statement above. * *

Yes

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