The Blissfield Elementary School encourages parents to become involved in the school in some capacity as a volunteer. In past years, the response has been very positive, in fact, usually we have more volunteers than we can accommodate. If you feel you could be on call in some capacity as a volunteer in the elementary school, please complete this form and return it to your child’s teacher. Prior to volunteering in the school, you will be required to fill out the opposite side of this paper to have a criminal background check completed.
Thank you for your interest in the Blissfield Elementary School.
Michael J. Valasek
I would like to help out in the Blissfield Elementary School as a volunteer in the following capacities:
____ Serve on Parent Advisory Committee
____ Serve on School Improvement Committee
____ Act as chaperone on field trips
____ Furnish healthy snacks for students (for M-Steps or Special Events)
____ Assist in the classroom
____ Assist in the Blissfield Elementary Life Lab (BELL)
____ Assist in the Library
____ Lunch Buddy
____Other, please specify_____________________________________________
2016-2017 Volunteer Application
Blissfield Elementary School
Full Name__________________________________________________________ Male or Female
First Middle Last
Maiden/Past Names Used (if any) ____________________________________________________
Birth Date___________________________________ Email__________________________________
(Required for background check)
Home Phone_____________________________ Cell Phone________________________________
Your Child’s Name:_________________________ Their Teacher:_________________________
In Case of Emergency Contact ______________________________________________________
First Last Phone
Military Service: Yes or No (circle one)
Branch_______________________________ Date Served___________________________________
Have you ever been convicted of a felony or misdemeanor? Yes or No
If you circled YES please explain (this may exclude you from volunteering) ________________________________________________________________________________________
I understand that:
1. The information I provided may be used to conduct a background check. This may include driving records, criminal records, and other records that are required by local, state or federal law for volunteers working with youth.
2. There are times when photographs are taken at events. I give my permission to Blissfield Community Schools to use my photograph and name for publicity purposes.
3. I understand that falsifying information on this form will result in being excluded from volunteering at Blissfield Community Schools.
4. I understand that because of the number of parents in the elementary school I may not be called.
(Volunteer Signature) (Date)
In order to volunteer for work in the school or to chaperone a field trip you must complete the Volunteer Application .