Parent/Guardian Volunteer Application

Please read the Parent/Guardian Volunteer Handbook on our Volunteer Page.

Parent/Guardian First Name:*

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Parent/Guardian Last Name:*

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Phone number:*

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Home Address

Street address:*

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City:*

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State:*

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Zip/Postal:*

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Student #1 - Full Name:*

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Student #2 - Full Name:

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Student #3- Full Name:

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Student #4 - Full Name:

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Add additional student's here:

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I am interested in the following volunteer opportunities:

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I understand that it is my responsibility to read and adhere to the volunteer guidelines stated in the parent volunteer handbook in an effort to protect the interest and safety of all students, employees and the school. *

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I agree

I acknowledge that I must disclose any criminal records as part of this application by completing and signing a criminal affidavit and that a change in my criminal status must be reported immediately to the head of school*

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I agree

Initials:*

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Parent Criminal History Affidavit

Please check what applies. *

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I certify that I am not registered as a sex offender in this state or any other jurisdiction and am not awaiting trial on or have not been convicted of committing or attempting, soliciting, facilitating or conspiring to commit one or more of the offenses listed in Section A of Addendum A (see below) in this state or the same or similar offenses in another state or jurisdiction as those offenses would prohibit me from volunteering at Villa Montessori School.

I am awaiting trial or have been convicted of committing or attempting, soliciting, facilitating or conspiring to commit one or more of the offenses listed in Section B of Addendum A (see below). I have indicated on the Addendum those that apply. I understand that it is up to the determination of the Head of School whether or not this will prohibit me from volunteering.

I am not awaiting trial and have not been convicted of committing or attempting, soliciting, facilitating or conspiring to commit any of the offenses listed in Section B of Addendum A.

This information will remain confidential.

ADDENDUM A

Section A:

1. Sexual abuse of a vulnerable adult.

2. Incest.

3. Homicide, including first or second degree murder, manslaughter and negligent homicide.

4. Sexual assault.

5. Sexual exploitation of a minor.

6. Sexual exploitation of a vulnerable adult.

7. Commercial sexual exploitation of a minor.

8. Commercial sexual exploitation of a vulnerable adult.

9. Child prostitution as prescribed in section 13- 3212.

10. Child abuse.

11. Felony child neglect.

12. Abuse of a vulnerable adult.

13. Sexual conduct with a minor.

14. Molestation of a child.

15. Molestation of a vulnerable adult.

16. Dangerous crimes against children as defined in section 13-705.

17. Exploitation of minors involving drug offenses.

18. Taking a child for the purpose of prostitution as prescribed in section 13-3206.

19. Neglect or abuse of a vulnerable adult.

20. Sex trafficking.

21. Sexual abuse.

22. Production, publication, sale, possession and presentation of obscene items as prescribed in section 13-3502.

23. Furnishing harmful items to minors as prescribed in section 13-3506.

24. Furnishing harmful items to minors by internet activity as prescribed in section 13-3506.01.

25. Obscene or indecent telephone communications to minors for commercial purposes as prescribed in section 13-3512.

26. Luring a minor for sexual exploitation.

27. Enticement of persons for purposes of prostitution.

28. Procurement by false pretenses of person for purposes of prostitution.

29. Procuring or placing persons in a house of prostitution.

30. Receiving earnings of a prostitute.

31. Causing one’s spouse to become a prostitute.

32. Detention of persons in a house of prostitution for debt.

33. Keeping or residing in a house of prostitution or employment in prostitution.

34. Pandering.

35. Transporting persons for the purpose of prostitution, polygamy and concubinage.

36. Portraying adult as a minor as prescribed in section 13-3555.

37. Admitting minors to public displays of sexual conduct as prescribed in section 13-3558.

38. Any felony offense involving contributing to the delinquency of a minor.

39. Unlawful sale or purchase of children.

40. Child bigamy.

41. Any felony offense involving domestic violence as defined in section 13-3601 except for a felony offense only involving criminal damage in an amount of more than two hundred fifty dollars but less than one thousand dollars if the offense was committed before the effective date of this section.

42. Any felony offense in violation of Title 13, Chapter 12 if committed within five years before the date of applying for a level I fingerprint clearance card.

43. Felony drug or alcohol related offenses if committed within five years before the date of applying for a level I fingerprint clearance card.

44. Felony indecent exposure.

45. Felony public sexual indecency.

46. Terrorism.

47. Any offense involving a violent crime as defined in section 13-901.03.

Section B:

1. Any misdemeanor offense in violation of Title 13, chapter 12.

2. Misdemeanor indecent exposure.

3. Misdemeanor public sexual indecency.

4. Aggravated criminal damage.

5. Theft.

6. Theft by extortion

7. Shoplifting.

8. Forgery.

9. Criminal possession of a forgery device.

10. Obtaining a signature by deception.

11. Criminal impersonation.

12. Theft of a credit card or obtaining a credit card by fraudulent means.

13. Receipt of anything of value obtained by fraudulent use of a credit card.

14. Forgery of a credit card.

15. Fraudulent use of a credit card.

16. Possession of any machinery, plate or other contrivance or incomplete credit card.

17. False statement as to financial condition or identity to obtain a credit card.

18. Fraud by persons authorized to provide goods or services.

19. Credit card transaction record theft.

20. Misconduct involving weapons.

21. Misconduct involving explosives.

22. Depositing explosives.

23. Misconduct involving simulated explosive devices.

24. Concealed weapon violation.

25. Misdemeanor possession and misdemeanor sale of peyote.

26. Felony possession and felony sale of peyote if committed more than five years before the date of applying for a level I fingerprint clearance card.

27. Misdemeanor possession and misdemeanor sale of a vapor-releasing substance containing a toxic substance.

28. Felony possession and felony sale of a vapor- releasing substance containing a toxic substance if committed more than five years before the date of applying for a level I fingerprint clearance card.

29. Misdemeanor sale of precursor chemicals.

30. Felony sale of precursor chemicals if committed more than five years before the date of applying for a level I fingerprint clearance card.

31. Misdemeanor possession, misdemeanor use or misdemeanor sale of marijuana, dangerous drugs or narcotic drugs.

32. Felony possession, felony use or felony sale of marijuana, dangerous drugs or narcotic drugs if committed more than five years before the date of applying for a level I fingerprint clearance card.

33. Misdemeanor manufacture or misdemeanor distribution of an imitation controlled substance.

34. Felony manufacture or felony distribution of an imitation controlled substance if committed more than five years before the date of applying for a level I fingerprint clearance card.

35. Misdemeanor manufacture of misdemeanor distribution of an imitation prescription–only drug.

36. Felony manufacture or felony distribution of an imitation prescription-only drug if committed more than five years before the date of applying for a level I fingerprint clearance card.

37. Misdemeanor manufacture or misdemeanor distribution of an imitation over-the-counter drug.

38. Felony manufacture or felony distribution of an imitation over-the-counter drug if committed more than five years before the date of applying for a level I fingerprint clearance card.

39. Misdemeanor possession or misdemeanor possession with intent to use an imitation controlled substance.

40. Felony possession or felony possession with intent to use an imitation controlled substance if committed more than five years before the date of applying for a level I fingerprint clearance card.

41. Misdemeanor possession or misdemeanor possession with intent to use an imitation prescription-only drug.

42. Felony possession or felony possession with intent to use an imitation prescription-only drug if committed more than five years before the date of applying for a level I fingerprint clearance card.

43. Misdemeanor possession or misdemeanor possession with intent to use an imitation over-the- counter drug.

44. Felony possession or felony possession with intent to use an imitation over-the-counter drug if committed more than five years before the date of applying for a level I fingerprint clearance card.

45. Misdemeanor manufacture of certain substances and drugs by certain means.

46. Felony manufacture of certain substances and drugs by certain means if committed more than five years before the date of applying for a level I fingerprint clearance card.

47. Adding poison or other harmful substance to food, drink or medicine.

48. A criminal offense involving criminal trespass and burglary under Title 13, Chapter 15.

49. A criminal offense under Title 13, Chapter 23, except terrorism.

50. Misdemeanor offenses involving child neglect.

51. Misdemeanor offenses involving contributing to the delinquency of a minor.

52. Misdemeanor offenses involving domestic violence as defined in section 13-3601.

53. Felony offenses involving domestic violence if the offense only involved criminal damage in an amount of more than two hundred fifty dollars but less than one thousand dollars and the offense was committed before the effective date of the section.

54. Arson.

55. Felony offenses involving sale, distribution or transportation of, offer to sell, transport or distribute or conspiracy to sell, transport or distribute marijuana, dangerous drugs or narcotic drugs if committed more than five years before the date of applying for a level I fingerprint clearance card.

56. Criminal damage.

57. Misappropriation of charter school monies as prescribed in section 13-1818.

58. Taking identity of another person or entity.

59. Aggravated taking identity of another person or entity.

60. Trafficking in the identity of another person or entity.

61. Cruelty to animals.

62. Prostitution, as prescribed in section 13-3214.

63. Sale or distribution of material harmful to minors through vending machines as prescribed in section 13-3513.

64. Welfare fraud.

65. Any felony offense in violation of Title 13, Chapter 12 if committed more than five years before the date of applying for a level I fingerprint clearance card.

66. Kidnapping.

67. Robbery, aggravated robbery or armed robbery.

I hereby certify under penalty of perjury that the answers given above are true and correct to the best of my knowledge and belief. Initials*

type initials here

Answer Required

Motor Vehicle Affidavit - Required if you will volunteer to drive.*

*If you do not plan to drive, you may type/select N/A

I understand that if I plan to be a driver for a field trip or activity, I must provide a copy of my driver's license, proof of insurance, and fingerprint clearance card. *

Answer Required

I agree

License plate number of the vehicle you will be driving:*

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Have you been involved in any vehicle collisions for which you were at fault in the past THREE years?*

Answer Required

Yes

N/A

If yes, please provide details below:

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Has your license EVER been suspended?*

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Yes

N/A

If yes, please provide details below:

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Has your license EVER been revoked in any state? *

Answer Required

Yes

N/A

If yes, please provide details below:

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Insurance

Answer Required

Choose a file or drag it here.

Driver's License

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Fingerprint Clearance Card*

Answer Required

Choose a file or drag it here.

*If you don't have a Fingerprint Clearance Card - you can find directions on our Volunteer Page.

A Fingerprint Clearance Card is required for all chaperones and volunteers who will ever be alone with a child (reading buddies, driving, field trips, overnights, going out, etc.).

I attest that all the information provided above is complete and accurate to the best of my knowledge. If my information changes, I understand that I must update this form before volunteering.

Parent/Guardian Signature:*

Signature Required

Villa Montessori School

Please fix the highlighted areas below before submitting.

Villa Parent/Guardian Volunteer Application

ADDENDUM A

Section A:

Section B: