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Adopted: December 1, 2009

Amended: December 16, 2015

CM Volunteer Registration Form - Exhibit 1

The Fort McMurray Public School District appreciates the services of all of its volunteers.  In order to ensure the safety of students, all volunteers in our schools need to be registered.  A volunteer is someone who assists school and/or students either in curricular or extra-curricular activities and includes volunteer drivers and students volunteering outside their school but does not include guest speakers, presenter, visitors to the school, parents who assist their own child in the school, or school council members in their position as school council members.  We hope that you will complete this form to enable the school in which you volunteer to exercise control over who should or should not be involved with the children.  The information collected on this form will be held in strict confidence.

If you are under 18 years of age your parent or guardian must sign this form.

Name of school or department:
Name:   Mr Mrs. Ms
  Surname
  Given Names
   
Address: Street
  City
  Province
  Postal Code
Phone: Day Time
  Evening
  Province
  Postal Code
Have you submitted a copy of your criminal record check?   Yes No
Has district policy on Conflict of Interest been provided to me? Yes No
I Agree to keep confidential any information I obtain or observe unless those actions are a breach of Confidentiality or Legislation Yes No
Do you have children or grandchildren registered in this school? Yes No

If yes, please list by name and grade:

Name: Grade:

If not, would you please list at least two references with whom the school may check:

Name: Telephone Number



X
 
Volunteer Signature


X

 
  Principal/Vice-Principal Signature
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