Yakima Adventist Christian School
1200 City Reservoir Road
Yakima WA  98908
Phone: 509-966-1933
Fax: 509-966-3907

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VOLUNTEER INFORMATION FORM
**for recertification only**
 

PERSONAL INFORMATION
 
Name   *
Address   *
City  *   State     Zip 
Home Phone   *   Cell Phone       
Email Address  
Occupation        Work Phone  
 
Employer     Supervisor

Current Church membership  *



  Have you moved in the last year: (from most recent) *
Dates Address
   


AVAILABILITY & INTERESTS(check all that apply)
 

How often do you want to volunteer?
Once a month   Once a week   More than once a week    For special events    
Mon. Mornings   Tues. Mornings   Wed. Mornings    Thurs. Mornings    Fri. Mornings
Mon. Afternoons   Tues. Afternoons   Wed. Afternoons    Thurs. Afternoons    Fri Afternoons
Evenings   At home   Before School    After School    

 

What type of volunteer work are you interested in?
Substitute Teacher   Teacher Assistant   Hot Lunch Assistant
Storytelling/Reading   Arts & Crafts   Janitorial Assistant
Field Trip Chaperone   Special Events/Programs   Grounds Assistant
Extra Curricular   Home & School Committee   Car Driver
Recess Supervisor   Assist with Computer Classes    Bus Driver
   Other, please specify  
 

HEALTH INFORMATION
 
 

Who should we contact in case of an emergency? *
Name Phone Cell
  Do you have any injuries, illnesses or physical limitations we should be aware of?
  Are you taking any medication we should be aware of in the event of emergency?
 
If yes, explain:
  Do you currently have any contagious or infectious diseases?
  Have you been exposed to TB?

If yes, explain:
 
 
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STATEMENT OF ACCURACY
The information contained in this form is current to the best of my knowledge. I understand that this is for strictly volunteer positions, and I expect no remuneration for services and time volunteered.
            I authorize any persons giving a reference or churches listed in this form to disclose information that they may have regarding my character and fitness for serving as a volunteer at YakimaAdventistChristianSchool. I hereby release any individual, church, or organization from any and all liability for damages which may result to me, my heirs, or family for compliance with this authorization, and agree that the school may maintain this information. My signature on this form confirms my understanding and agreement that: In the event that allegations of criminal or sexual misconduct arise regarding my conduct while I serve in a volunteer capacity, the school will fully cooperate with any investigation. I further state that I have carefully read the foregoing release and understand the contents, and that I sign this release at my own free act. This is a legally binding agreement, which I have read and understand.
            Further, I will participate in regular volunteer orientation and/or training programs conducted by the school. I have read and agree to follow the Guidelines for Volunteers, and I give my consent for the criminal history record check.


Please be sure you have answered the questions.  Uncomplete applications will not be accepted.
 

*  By emailing this form you agree each statement is true and that you have answered each question 
               to the best of your ability.