Family Service of Lake County- LYI & YESS Tutor Volunteer Application 2020-2021
LYI & YESS Virtual Academic program runs Mondays through Thursdays with an optional "Open Study Hall" on Fridays from 4-5pm that will take place on Zoom. The programs begins on October 6th and ends on May 20th with Open Study Hall officially starting on October 16th. LYI & YESS students will be 6th through 12th graders.

We are currently looking for homework volunteers/tutors that will be available to help on Fridays. Our "Open Study Hall" is a pilot optional programming day this year, therefore, we will not have a total number of students that will attend each Friday. LYI & YESS students are required to sign up for open study hall by each Wednesday in order to know how many volunteers will be needed. It is important for volunteers to understand that they will not always be required on Fridays but they will be "on-call" for Fridays until Wednesday. If students sign up for tutoring help on Fridays, all volunteers will be contacted in order to see who can volunteer that week (if volunteers don't confirm their participation by the end of Thursday they will not participate in that week's study hall). If volunteer is a current high school student, they will only be able to work with the middle school program, if over 18 years old and no longer in high school, volunteers will be assigned to work with the high school program students. If you are interested in volunteering, please fill out the form below and you will be contacted by a program facilitator.

All volunteers will have to attend a Mandatory Volunteer Training

October 9th 3:30-4:30pm via Zoom (Link will be provided the week prior to training)

The following Fridays there will be no study hall:
October 30th
November 20th
November 27th (Thanksgiving Holiday)
December 18th - January 8th (H.S Finals week/Winter Break)
January 29th
February 26th
March 19th - April 2nd (Spring Break)
April 30th
May 20th (End of Programming)

***IF YOU PREFER A PAPER COPY, PLEASE SEND REQUEST TO MAMEZQUITA@FAMSERVICE.ORG or BACOSTA@FAMSERVICE.ORG

GENERAL INFORMATION
Name
Date
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DD
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Address, City, State, Zip-code
Mobile
Email
Age
Date of Birth
MM
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DD
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YYYY
If you are under 18, please fill out:
Name of Parent or Legal Guardian
Address, City, State, Zip-code
Phone Number
Emergency Contacts (Used in the case of in person tutoring)
In case of an emergency, please notify
1) Name, Number and Relationship
2) Name, Number and Relationship
List all known allergies/medical conditions you have
OTHER INFORMATION
l. Special Skills
Please list any special talents you may want to share with the children
Spoken languages
Indicate which classes/subjects you wish to tutor
Please note that depending on number of volunteers or student needs, you might be assigned to different subjects each time
Subjects
Please write below what grade level in each subject you are comfortable tutoring.
ll. Experience
List your past volunteer experience
Clear selection
What experience do you have working with youth?
lll. Interest
Program desire to work with
Why are you interested in volunteering at Family Service of Lake County?
lV. Availability
Please list any known Friday absent dates during the school year which you will not be able to participate:
V. Criminal Background Check:
Have you ever been convicted of a felony? (Pick yes or no)
Clear selection
If yes, please explain
Vl. Signature
Signature & Date
Signature of Parent/Guardian (if under 18 years of age):
***IF REQUESTED A PAPER COPY OF THIS APPLICATION, PLEASE RETURN THIS APPLICATION TO LYI & YESS STAFF MAMEZQUITA@FAMSERVICE.ORG BACOSTA@FAMSERVICE.ORG
Vll. Permission Forms
LYI & YESS Tutor Volunteer 2020 PHOTO RELEASE
I hereby authorize Family Service of Lake County to photograph, copyright, use and publish my photographic or video image or the photographic or video image of my minor child. I understand that the photographic or video image may be produced and released in any form, in whole or in part, with such alterations and changes Family Service desires, and that the images may be done separately or with my name or name(s) of my minor child included in the release.I understand that the purpose of the use or release of the photographic or video images will be for publicity purposes.The use or release of the images will be made either to the public or within Family Service or both, including, without limitation, commercial or noncommercial publications and exhibits.I agree that all pictures, reproductions, plates, negatives and tapes of any kind relating to the images are and shall remain the property of Family Service of Lake County. I understand that this Authorization for Photo Release can be revoked by me at any time by submitting a written request to: Family Service of Lake County, 777 Central Avenue, Highland Park, IL 60035 (Name of Volunteer)
Signature & Date
Signature of Parent/Guardian (if under 18 years of age):
LYI & YESS 2020 LIABILITY FORM
As a participant in Family Service of Lake County’s programming, I acknowledge that there are certain inherent risks in participating in recreational, competitive, educational, and/or performance activities. In addition, I realize and acknowledge that there exists the possibility of an unforeseen accident and/or natural calamity causing harm to me or my child. I hereby release and agree to hold harmless Family Service of Lake County, its employees, Nuestro Center, District 112, District 113 and its directors, participants and volunteers of any and all claims I, or my minor child may have against them for injuries or damages suffered by me or my minor child and his/her property while participating in the LYI & YESS activities. I recognize that there may be occasions where I or my child may be in need of First Aid or emergency medical treatment. I do hereby give permissions for agents of the LYI & YESS Summer program to seek and secure any needed medical attention or treatment for me, or my minor child, including hospitalization, in the event that I am unable to be contacted immediately. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment. By signing this Waiver of Liability, I acknowledge that I have read this document, I have inspected the facility and accept it as being safe and reasonably suited for the intended purposes, and I voluntarily sign this document. I understand that the foregoing is a release of liability that is legally binding on me, the named child, our heirs, and our legal responsibilities.
Signature & Date
Signature of Parent/Guardian (if under 18 years of age):
Submit
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