Dysart Volunteer Application
BEFORE COMPLETING THIS FORM, PLEASE REVIEW THE VOLUNTEER HANDBOOK. Once you have completed your review of the Volunteer Handbook, please complete all questions and click submit! Your results will be received and reviewed by the Volunteer and Compliance Specialist. Once all information is validated, the Specialist will contact you to make an appointment for final steps in becoming an approved volunteer for the Dysart Unified School District. Thank you in advance for your service to our students and school community!
Email address *
Last Name *
First Name *
Street Address *
City *
Zip Code *
Home Phone Number *
Cell Phone *
Emergency Contact #1: Name, Phone, Email *
Emergency Contact #2: Name, Phone, Email *
Family Physician Name and Phone:
List any medical conditions or allergies, NA if none *
Have you previously volunteered at DUSD? *
Do you have a school preference? (Select all that apply) *
Please provide a brief description of the program, team, class, or activity, the direct supervisor in this area, and the work you've been asked to volunteer for: *
Will you be serving on a booster or parent group as a part of your volunteer work: *
Do you have a current First Aid/CPR Certificate? *
Do you have a current Fingerprint Clearance Card *
COACHES ONLY: By entering my name below I agree to the following terms as a DUSD volunteer: 1.) Volunteers must always have a certified head or assistant coach in the direct vicinity of the sporting activity. 2.) Volunteer coaches will be expected to follow all district policy and athletic department guidelines.3.) Volunteer coaches will not be allowed to drive district vehicles.4.) Volunteer coaches shall not administer discipline to any athlete under any circumstances.Discipline shall only be done by a certified coach employed by Dysart Unified School District.5.) District health insurance or workman’s compensation will not cover volunteer coaches. The district will be protected by its general liability policy when using volunteer coaches. Volunteer coaches must complete all required documentation required by the district, including a fingerprint clearance and background check.6.) Volunteer coaches agree to log all volunteer hours into the volunteer attendance computer program available online.7.) Volunteer coaches must wear a district-issued name badge at all times for proper identification.8.) Volunteer coaches understand that this is a volunteer position only. No compensation will be given.9.) Volunteer coaches understand that this is a volunteer position only. No compensation will be given.“I have read, understand, and will abide by all rules set forth in the Coaches Athletic Handbook and the Parent & Athlete Informed Consent & Codes of Conduct Handbook. I also agree to adhere to the guidelines for volunteering as a coach for any Dysart Unified School District athletic program.”
HANDBOOK AND ORIENTATION AGREEMENT: By entering my name below I hereby attest that I have fully read and agree to all terms described in the Volunteer Handbook. I understand that I cannot begin volunteering until I have met with and been fully cleared by the Dysart Unified School District Volunteer and Compliance Specialist, I certify the answers I've provided on this form are true, accurate and complete. I understand any misrepresentation of fact, false statements, or material omissions will result in the cancellation of my volunteer status with Dysart Unified School District. I also understand that district health insurance or workman’s compensation insurance will not cover any incidents that may occur while I am volunteering for the district. *
CONFIDENTIALITY AGREEMENT: By entering my name below I agree, as a volunteer of Dysart Unified School District #89, have been informed of my personal responsibility to honor and protect confidential matters and documents to which I have been exposed or have access to in my official volunteer duties.Furthermore, I understand and agree that willful violation of the confidentiality of any student’s school related information shall result in immediate removal from my volunteer assignment.Volunteers are required to comply with all requirements concerning handling of and exposure to confidential in formation and materials in the school setting. My name below attest to my agreement regarding the confidentiality requirement for volunteers. *
STATEMENT OF UNDERSTANDING: Please read the following statement carefully and indicate your understanding and acceptance by entering your name below. My agreement below constitutes authorization to check my employment history, including without limitation,criminal arrest and conviction record checks, reference checks, and release of investigatory information possessed by any state, local or federal agency. I further authorize those persons, agencies or entities that the Dysart Unified School District #89 contacts in connection with my volunteer application to fully provide the Dysart Unified School District #89 with all information it requests.I hereby release the Dysart Unified School District #89, its members, employees and agents from any claims, including without limitation, defamation, emotional distress, invasion of privacy or interference with contractual relations that I might otherwise have against the Dysart Unified School District #89, its agents, officials, or against any provider of such information.I understand that information submitted in and with this application may be disclosed to a screening and/or interviewing committee, which may include Board Members, administrators, other staff and members of the community. I give my consent to this disclosure.I certify that I have read this form in its entirety and that the information herein provided is true, accurate and complete. I understand that, should any statement I have made prove to be false, or misleading, it may result in the rejection of my volunteer application or in my discharge if I am volunteering. If already volunteering, I also understand that any misstatement or omission of fact on this application may result in my discharge.I understand that all documents I provide to Dysart Unified School District #89 as part of my volunteer application will become property of Dysart Unified School District and will not be returned. *
A copy of your responses will be emailed to the address you provided.
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