Volunteer Application

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Synergy Magnet K12

Email *

Name *

Adress *

Phone# *

Date of Birth *

YYYY

Gender *

Male

Female

Email Address *

Child's Name *

Child's grade level *

PK4 - 5th grade

6th - 8th grade

9th - 12th grade

Teacher *

Emergency Contact *

Emergency Contact Phone# *

References

Please list 2 people whom you have know for at least 2 years

Reference Name *

Reference Phone# *

Reference Name *

Reference Phone# *

Please check as many items in each group as you wish

Do you prefer working with *

Individual Children

Small Groups

Required

Type of volunteer service preferred *

Field Trip Chaperone

Classroom Assistant

Parent Involvement Group

Volunteer Coach Assistant

Guest Speaker

Required

Do you speak a second language? *

Yes

If so, what?

Do you have an area of expertise, hobby, talent, skill, etc. which you would like to share with the students of Synergy Magnet K12 upon teacher request? If so, please explain. *

For the safety and protection of our students, please answer the following:

Are criminal charges other than minor traffic violations currently pending against you? *

Yes

Have you ever been convicted and/or found "guilty" of a criminal offense? *

Yes

Have you ever entered a plea of "guilty" in a court of law to any criminal offense? *

Yes

Have you ever pled "no contest" in a criminal proceeding? *

Yes

Have you ever had adjudication withheld in a criminal proceeding? *

Yes

Are you currently serving probation, parole, or community service as part of a court order? *

Yes

If you checked "YES" to any question above you MUST list each and ALL charges or offenses separately. Include dates, city, state, and other locations where the offense(s) occurred. Also include an explanation of each charge or offense in your words, including the final outcome. Failure to disclose arrest information will disqualify you. It is the policy of the Synergy Magnet K12 to request criminal background checks for people who participate with student activities.

I certify the above entries are true, complete, and correct to the best of my knowledge and belief and are made in good faith. *

INITIAL BELOW

I understand that a knowing and willful false statement on this form may result in immediate dismissal from the volunteer program. *

INITIAL BELOW

Initial Below *

Name *

Date *

YYYY

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