Hearst Volunteer Clearance Form 2017-18
Parent's First Name
Your answer
Parent's Last Name
Your answer
Address - Street Number and Name
Your answer
City and Zip Code
Your answer
Parent Volunteer Date of Birth
MM
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DD
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YYYY
Gender
Phone Number
Include Area Code
Your answer
CA Driver's License or CA ID Number
Your answer
Other School Sites
Agreement
I authorize the Pleasanton Unified School District to submit this information to the Pleasanton Police Department to complete the volunteer screening process.
Signature
Your answer
Today's Date
MM
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DD
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YYYY
Optional: Donate the cost to cover the volunteer screening
It costs the district $6.00 to conduct a clearance check. Make checks payable to Pleasanton Unified School District
Confidentiality Statement
I understand that in the course of my volunteer association with the Pleasanton Unified School District, I share the responsibility of maintaining student, employee and District confidentiality as to any information whether written, verbal or by actions observed, which I may have available to me. I further understand that in the course and scope of my volunteer status, I am not to discuss academic, social or other confidential information regarding students or school employees with anyone, including the parents of any student. Any breach of confidentiality will be carefully reviewed by Pleasanton Unified School District and, if substantiated, may result in the termination of my volunteer involvement with the school district.
Signature
Your answer
Today's Date
MM
/
DD
/
YYYY
Submit
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