Volunteer Clearance Form 2017-18
This form needs to be completed every year in order to be cleared to be on campus working in classrooms, helping at school wide events and even for field trips. Please allow for a few weeks for clearance so the sooner you can get the information in, the better. This also is needed for each family member individually. Thanks for your time in helping out at Vintage Hills Elementary School.
Student Name
Your answer
Parent First Name
Your answer
Parent Middle Name
Your answer
Parent Last Name
Your answer
Address - Street Number and Name
Your answer
Address - City and Zip Code
Your answer
Date of Birth (of Parent Volunteer)
MM
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DD
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YYYY
Gender
California Driver's License or California I.D. Number
Your answer
Phone Number
Please include area code first
Your answer
Other School Sites
Signature
By typing my name I authorize the Pleasanton Unified School District to submit this information to the Pleasanton Police Department to complete the volunteer screening process.
Your answer
Today's Date
MM
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DD
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YYYY
Optional: Donation amount to cover the cost of volunteer screening
For your reference, it costs the district $6.00 to conduct a clearance check. (Make checks payable to Pleasanton Unified School District)
Your answer
Confidentiality Statement
I understand that in the course of my volunteer association with 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
By typing your name you understand that you are agreeing with the Confidentiality Statement above
Your answer
Today's Date
MM
/
DD
/
YYYY
Submit
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