23-24 Volunteer Registration revised

First & Last Name

Address, city, state & zip code

Email

Phone

Do you prefer text messages?

Birth date

Do you have any allergies?

If a student, please list school & graduation date.

Occupation

Source of referral to CLASP

Do you have teaching experience or other experienc working with children? (not required)

Preferred method of tutoring.

In person

Online

Either

Preferred grade level to tutor (grades 1 - 6)

Emrgency contact name, relationship, primary phone number & second phone number

I have results of a negative TB test within the last 4 years & will provide paperwork to CLASP.

Yes

No

Have you ever been convicted of a felony or misdeamor crime, other than a traffic violation?

Yes

No

Has a civil or criminal complaint ever been filed against you that alleged misconduct or child abuse by you or your participation in or facilitaton of such activities?

Yes

No

Have you ever chosen not to renew or continue any employment or volunteer service, had your employment or volunteer service terminated, or been subject to any internal disciplinary action relating to allegations of any misconduct or child abuse by you? If

Yes

No

I accept the terms of volunteering for CLASP as printed on the Volunteering page of the website.

Signature & date