Our school is a vital part of the community. Respecting one’s privacy and confidentiality is very important:
Each student with whom you work has the right to expect that nothing that happens to or about him or her will be repeated to anyone other than authorized school department employees, as designated by the administrators at your school. Even when discussing a student with those who are directly involved in a student’s education, such as a teacher, principal, or guidance counselor, you may not share otherwise confidential information with them unless it is relevant to the student’s educational growth, safety, or well-being.
You may not share information about a student even with others who are genuinely interested in the student’s welfare, such as social workers, scout leaders, clergy, or nurses/physicians (a grave medical emergency, in which confidential information may be necessary for a student’s care, is the only exception). Thus, you must refer all such questions to the school employees so authorized and indicated to you, typically the student’s teacher or principal.
Parents, friends, or community members may, in good faith, ask you questions about a student’s problems or progress. Again, you must refer all such questions to the authorized school employees. You may not share information about a student, even with members of your own family or his/her family.
Volunteer Liability and Indemnification
A volunteer shall at all times indemnify and hold harmless Dunkerton Community Schools and its officers, agents and employees from any and all claims, damages and expenses arising out of injuries to persons or damage to property which resulted from any omissions or negligent acts of the volunteer.
I understand and agree that I will not disclose such confidential information except to school employees that have a need to know.
______________________________ ____________________________ ______
Signature Printed name Date
|
It is the policy of the Dunkerton Community School District to make every reasonable effort to provide a safe learning environment for students working with volunteers. Therefore, the District requires the following confidential information from volunteers who work directly with students or assist staff on a regular basis; supervise/chaperone students; or act as a primary authority figure. This statement must be completed and returned to the District office prior to beginning any volunteer experience. *Background checks are good for five years from date of completion. |
|
Name: |
(first) |
(last) |
|
Address: |
|
|
City: |
State: |
Zip: |
|
Day Phone: |
Evening Phone: |
|
Do you have any record of drug or alcohol arrests? |
Yes No |
|
Have you ever been convicted of a serious misdemeanor, aggravated misdemeanor, or a felony under Iowa law or any other state/country law? |
Yes No |
|
Have you ever been convicted, or had an administrative finding, of violating any law involving child abuse, sexual abuse, physical abuse, sexual harassment or exploitation, or any other crime related to children? |
Yes No
|
|
Have you ever been the subject of or listed as the perpetrator in a founded child abuse report? |
Yes No
|
|
Are you required to register as a sex offender with the Sex Offender Registry? |
Yes No
|
|
Do you currently have charges pending or are there any ongoing investigations relating to any of the previous questions? |
Yes No
|
|
Has your driver’s license ever been suspended or revoked? |
Yes No |
*A “Yes” answer to any of the questions listed above may require an interview with a district administrator.
Signature: _______________________________ Date: _____________________
