DCSC Volunteer Background Information Check
The information collected within this form is required to submit to a criminal-history background check.
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In which building are you interested in volunteering? *
Legal First Name *
Middle Initial
Legal Last Name *
Your date of birth (MM/DD/YYYY) *
Ex. 03/24/1987

Gender, assigned at birth
 *
Race, select one *
Complete mailing address (street, city, state, zip) *
Ex. 123 Main St. Delphi, IN 46923

Phone number *
By electronically signing below, I am affirming the information supplied is correct. Any false or misleading information will be interpreted as willful misrepresentation and shall be sufficient grounds to be refused the right to volunteer at any DCSC school or event. Also, I agree to abide by all relevant School Board Policies and administrative guidelines while on duty. I understand that, although I am covered under the Corporation’s liability insurance policy, I am not
covered by its health insurance policy nor am I eligible for worker’s compensation. Should I become ill or suffer an accident while doing volunteer work, I agree that I shall be responsible for any and all hospital and medical charges that may accrue. I further understand that I am not in any manner considered an employee of DCSC or entitled to any benefits provided to employees. I further release the board from any and all liability for any
damages, whatever their nature, which may result as a consequence of my volunteer service. Every new school year will require a new criminal history check. My signature below constitutes authorization to check my criminal history.

Type in your full name as you would sign a document.
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