URBANA ELEMENTARY SCHOOL VOLUNTEER CONFIDENTIALITY AGREEMENT
I understand that the work I do is of great benefit and service to Urbana Elementary. As part of my volunteerism, I may see, hear, or be in the vicinity of information regarding students and staff.

By filling out the form below, I agree that I will preserve confidentiality for all information seen or heard during the course of my volunteer hours, and uphold our principle of honor at Urbana Elementary School. I also agree that I have viewed all of the Volunteer Presentations available on the Urbana Elementary School Homepage.

Email address *
Name: *
Your answer
Date: *
Your answer
Your Phone Number: *
Your answer
Student Name(s): *
Your answer
Emergency Contact #1: *
Your answer
Relationship to You: *
Your answer
Contact's Phone Number: *
Your answer
Contact's Alternate Phone Number: *
Your answer
Emergency Contact #2:
Your answer
Relationship to You:
Your answer
Contact's Phone Number:
Your answer
Contact's Alternate Phone Number:
Your answer
Physician's Name:
Your answer
Physician's Phone Number:
Your answer
Allergies or Other Health Concerns: *
Your answer
Typing My Name Below and Submitting this Form Acts as My Binding Electronic Signature: *
Your answer
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