Volunteer Criminal Record Check and Background Affidavit
Thank you for your interest in volunteering at Allegan Public Schools! Please complete this form for each event that you are volunteering for.
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What is your FIRST NAME? *
What is your MIDDLE NAME?
You may skip this question if you do not have a middle name.
What is your LAST NAME? *
What is your BIRTHDATE? *
MM
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DD
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YYYY
What is your RACE? *
What is your GENDER? *
Please list ANY OTHER NAMES you may be known as:
These may include former names, a maiden name, etc. You may skip this question if this does not apply to you.
What is your STREET ADDRESS? *
What is your CITY? *
What is your ZIP CODE? *
What is your PHONE NUMBER? *
What is your VOLUNTEER ASSIGNMENT? *
Required
WHERE will you be volunteering? *
Required
If you have been convicted or have pled guilty or no contest to any crime, misdemeanor, or felony, please provide an explanation of this below: *
Non-disclosure of any unlawful activity will result in not being approved to volunteer for Allegan Public Schools.
Consent for Criminal History Check/Disclaimer of Convictions/Authorization & Release
I authorize the Board of Education of Allegan Public Schools, or its agent, to request the Criminal Records Division of the Michigan Department of State Police to conduct a criminal history check of my records for the purpose of evaluating my qualifications for volunteering at Allegan Public Schools.

I will abide by all Board policies and administrative guidelines while on duty for the Allegan Public School District, including the Tobacco-Free Schools Act prohibiting the use of tobacco products at all times in all buildings and grounds.

I understand that transportation for trips and activities provided by volunteers in private cars requires the driver/owner to provide his/her own insurance, maintenance, and operating expense for his/her vehicle.

I realize that as a volunteer I am not in any manner considered an employee of the District or entitled to any benefits provided to employees. Should I become ill or suffer and accident while doing volunteer work for the District, I agree that I shall be responsible for any and all medical costs that may accrue.

I further release the Allegan Public School District, its Board of Education, and individual employees or agents of the school from any and all liability for damages which may result as a consequence of my volunteer service.
Your SIGNATURE: *
Typing your name signifies consent authorizing Allegan Public Schools to conduct a background check.
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