Volunteer Form

	Name*

	Address*
	Street Address   City, State Zip Code

	Phone Number - Numeric only, do not insert dashes*

	E-mail address*

	Please provide the following information:*
	Student Name   School   Grade   Teacher Child 1         Child 2         Child 3         Child 4

	Please indicate which schools you would like to serve as a volunteer:*
	High School    Middle School    Bellefonte Elementary    Benner Elementary    Marion-Walker Elementary    Pleasant Gap Elementary

	Days of the week you are available:*
	Monday    Tuesday    Wednesday    Thursday    Friday    Any

	When/how often would you like to volunteer?*
	Mornings    Afternoons    Once a week    Once a 6 day cycle    Once or twice a month    Anytime    Other, please specify

	Check the type of work you wish to do:*
	Work with groups of students    Individual student tutoring    Clerical or library work    Substitute for regular volunteer    Assist students with computers    I have a hobby/talent/job I wish to share    Accompany class on field trips    Assist teacher with parties/special events    Other, please specify

	Have you been a volunteer before?*
	Have you been a volunteer before?* Yes No

	If yes, for whom?
	Teacher   School   Grade   Year

	Statement of Confidentiality: I understand that in the course of my association with the Bellefonte Area School District, I share the responsibility of maintaining the confidentiality of any employee or student information that I may have available to me. I understand that it is my responsibility to assure rights and confidentiality of information both written and verbal. As a volunteer, I will work with the highest standards, committed to the idea that my work will benefit students. I understand that in the performance of my duties, I am not to discuss academic or other confidential information regarding students or employees with anyone. Any breach of confidentiality will be carefully reviewed and if substantiated could result in termination of volunteer involvement with the School District, and may result in legal action. Acknowledge that you have read and understand this statement by typing "I Agree" in the box below. MUST TYPE IN "I AGREE"