Volunteers & Chaperones FY16 revised 7/29/15

Lowndes County Schools Volunteer Procedures:

Definition of a volunteer: Volunteers-Anyone providing supervision while actively interacting with students, or anyone having responsibility of students Requirements of volunteers before they are allowed to interact with students: A. Watch the DOE Mandated Reporter PPT. http://www.gadoe.org/Curriculum-Instruction-and-Assessment/Curriculum-andInstruction/Documents/Child%20Abuse%20Prevention%20Powerpoint%20Presentation.pdf B. Consent to local background check. Principal will be notified if an issue is identified on the background check. C. Sign the volunteer statement indicating the PPT has been viewed and that the school protocol and mandated reporting law is understood. Identification of volunteers after completing the requirements: A. An ID is provided to the approved volunteer for the current school year with expiration date noting they are a registered volunteer. B. Volunteers will show a volunteer card and photo id before performing volunteer activities. C. Schools will designate a certified staff member to maintain the signed statements.

Volunteers & Chaperones FY16 revised 7/29/15

Statement Requiring Volunteer Signature: Lowndes County Schools Volunteer Statement 2015-2016 After receiving training, I confirm the following: 1. I have watched a Mandated Training PPT provided by LCS. 2. I understand that it is law that I report immediately any suspected abuse. Reports are made to a school administrator or counselor as this is LCS policy. I understand it is a crime if I do not report suspected abuse. 3. I understand when I make a report or cause a report to be made, mandated reporters only need to have “reasonable suspicions” not direct evidence. 4. I understand it is against the law for any mandated reporter to notify the parent that a referral has been made. It is the policy of DFACS that Child Protective Services notify the parent upon investigation. 5. I will not conduct an investigation, and will not interrogate a child for any reason. 6. I will keep all matters confidential. This is a legal mandate as well as something I would demand if the situation involved my family. These children deserve the same privacy.

Volunteer Signature: ______________________________________________ School Designee Signature: _________________________________________ Date: _______________________

Please return form with a copy of your driver's license.

Volunteers & Chaperones FY16 revised 7/29/15

Lowndes County Sheriff’s Office Criminal History Search Consent Form   I hereby authorize the Lowndes County Board of Education to receive any Georgia criminal history record information pertaining to me, which may be in the files of any state or local Criminal Justice Agency in Georgia. Results may be released to Tina Wright, Lowndes County Schools – Human Resources Department.

_______________________________________________________________ Full Name – Printed

_______________________________________________________________ Address

City

State

Zip Code

_________________ Sex

Race

Date of Birth

Social Security Number

_______________________________________________________________ Signature

Date

________________________________ Contact number

Special employment provisions (check if applicable): Employment with mentally disabled (Purpose Code ‘M’) Employment with elder care (Purpose Code ‘N’) Employment with children (Purpose Code ‘W’)

Notary Public, Lowndes County, GA My commission expires ___________________ _______________________________________ Notary Signature

Please return form with a copy of your driver's license.

Volunteers & Chaperones FY16 revised 7/29/15

Volunteer’s Personal Affirmation Volunteer’s Name: __________________________________________________________________________________ Please Print Last Name, First Name and Middle Initial Address: _______________________________________________________________________________________________ Contact Numbers: __________________________________________ Home/Cellular

___________________________________ Work

Instructions: The Volunteer must enter a "Yes" or "No" response to each of the following questions. All questions must have a response (please circle your responses) in order for the volunteer process to continue. Please attach an explanation for any "YES" response. 1.

Yes

No Are you the subject of a pending investigation involving a criminal act?

2.

Yes

No Are you currently the subject of an investigation involving sexual misconduct or physical harm to a child?

3.

Yes

No For any misdemeanor and/or felony criminal offense, have you ever:

♦ Pled guilty; ♦ Entered a plea of nolo contendere; ♦ Entered an Alford plea; ♦ Been found guilty; ♦ Pled guilty to a lesser offense; ♦ Been granted first offender treatment without adjudication of guilt; ♦ Participated in a pre-trial diversion program; ♦ Been found not guilty by reason of insanity; or ♦ Been placed under a court order whereby an adjudication or sentence was withheld? 4. Yes

No Have you ever been convicted, or pled to a lesser offense for any sexual offense?

5. Yes

No Have you been convicted of a drug offense (felony or misdemeanor)?

AFFIRMATION I affirm that my responses are true and correct. I hereby give permission to Lowndes County Schools to obtain copies of any criminal records relating to me which are held by any local, state or federal government agency. I authorize any such agency or entity to release those records to Lowndes County Schools. Signature: __________________________________ Date: ________________________ NOTE: This Volunteer’s Personal Affirmation must be completed, signed, dated, received by the school principal and approved by the system before the volunteer activity begins. This Volunteer’s Personal Affirmation will be valid for the current school year. A new Volunteer’s Personal Affirmation will be required for each subsequent school year.

Thank you for your cooperation in this matter of mutual concern.

Please return form with a copy of your driver's license.

Lowndes County Schools Volunteer Procedures

Jul 29, 2015 - I hereby authorize the Lowndes County Board of Education to receive any Georgia criminal history record information pertaining to me, which may be in the files of any state or local. Criminal Justice Agency in Georgia. Results may be released to Tina Wright, Lowndes County. Schools – Human Resources ...

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