Volunteer Criminal Record Check & Background Affidavit
For Volunteer service to the District - You only need to complete this 1 time for each school year
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Your answer
List all Other Names - Former/Maiden Names (or type "none") *
Your answer
Address *
Your answer
Phone Number *
Your answer
Race *
Gender *
Date of Birth *
**If you are using Internet Explorer - you MUST verify the year of birth
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Volunteer Assignment *
Required
Building/Department *
Required
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 wile 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.


Have you been convicted of, or pled guilty to or no contest to any crimes (misdemeanors or felonies)?
Signature of Volunteer *
Typing my name signifies consent authorizing Allegan Public Schools to conduct this background check
Your answer
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