Emmons School Dist 33 Volunteer Information Form & Waiver of Liability

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Email *

First & Last Name *

Address *

Are you now or have you ever been a school volunteer? *

Yes

Required

Students names that attend Emmons *

Criminal Conviction: Are you a child sex offender? *

Yes

Have you ever been convicted of a felony? *

Yes

If you have been convicted of a felony, list all offenses. (Offense, Date & Location)

If requested, are you willing to consent to a criminal history records check? *

Yes

Waiver of Liability - The School District does not provide insurance coverage to non-District personnel serving as volunteers for the School District. The purpose of this waiver is to provide notice to prospective volunteers that they do not have insurance coverage by the School District and to document the volunteer’s acknowledgment that they are providing volunteer service at their own risk. By indicating yes below: You acknowledge that the School District does not provide insurance coverage for the volunteer for any loss, injuries, illness, or death resulting from the volunteer’s unpaid service to the School District.You agree to assume all risk for death or any loss, injury, illness, or damage of any nature or kind, arising out of the volunteer’s supervised or unsupervised service to the School District. You also agree to waive any and all claims against the School District, or its officers, School Board Members, employees, agents or assigns, for loss due to death, injury, illness or damage of any kind arising out of the volunteer’s supervised or unsupervised service to the School District. *

Yes, I understand and agree. By indicating yes, I understand this serves as my digital signature.

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