PRINT CHILD’S NAME ROOM #
2015–2016 Student Mandatory Forms / Required Documents
PLEASE NOTE: This is an STUDENT FORMS: interactive PDF that you can fill out on your computer using THE FOLLOWING ARE REQUIRED FORMS THAT MUST BE COMPLETED FOR Adobe Reader. Duplicate fields EACH STUDENT AND RETURNED WITHIN THE FIRST WEEK OF SCHOOL: will fill in automatically to save you time. Please PRINT and SIGN each page. No forms will o Student Information Verification/Data Sheet be accepted via e-mail. We still This TWO-SIDED data sheet from the school district is stapled to the front of the need paper forms, with a legal manila first day packet envelope. Please review both front and back. Cross out signature, for filing in the office. any incorrect information and write in current information. Medical information is not collected here so this does not need to be added. (Also stapled to the Important: Please print these envelope is your student’s Source Registration letter; keep this for reference forms single-sided, unless the since you may need this to log in to the Source for your student’s info.) form is two-sided. If unable to print forms, please email Cindy o FERPA Release Form at [email protected]. Seattle Schools requires that this is the only form that can be used to opt your A hard copy will be sent home. child out for directory release information. By law, this includes yearbook.
o Emergency Information and Student Release Form
o Student Health Information Form PLEASE NOTE: You can print this form double-sided. Your signature These forms are filed by is required on the back side of the form. student name, not by family. o Thornton Creek Walking Field Trip Form PLEASE COMPLETE ONE COPY OF EACH FORM o Student Housing Questionnaire FOR EACH STUDENT.
Please check each box on this check list (as you complete each form) to ensure that you return a complete packet.
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300 Pre-K to 8 FERPA FORM
SEATTLE PUBLIC SCHOOLS (SPS) NOTIFICATION OF RIGHTS UNDER THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA) and OPT-OUT FORM
Under the Family Educational Rights and Privacy Act (FERPA), parents/guardians of students under age 18, and students over 18 years of age (“eligible students”) have certain rights with respect to student “education records.” If the student is 18 years old, even if living with the parent/guardian, the student has all the rights under this Act. These rights are:
(1) The right to inspect and review their education records within 45 days of the day SPS receives a written request.
(2) The right to request the amendment of an education record for a student that the parent or eligible student believes is inaccurate, misleading, or is in violation of the student’s right to privacy. If SPS decides not to amend the record, SPS will notify the parent/guardian or eligible student of the decision and advise them of their right to a hearing regarding the request for amendment. Additional information regarding the hearing procedures will be provided to the parent/guardian or eligible student when notified of the right to a hearing.
(3) The right to provide written consent before the school discloses personally identifiable information contained in the education records of a student, except to the extent that FERPA authorizes disclosure without consent. One exception that permits disclosure without consent is disclosure to school officials with legitimate educational interests. A “school official” is a person employed by SPS as an administrator, supervisor, instructor, or support staff member (including health or medical staff and law enforcement unit personnel). A “school official” also may include a volunteer or contractor outside of the school who performs an institutional service or function for which the school would otherwise use its own employees and who is under the direct control of the school with respect to the use and maintenance of personally identifiable information from education records, such as an attorney, auditor, medical consultant, or therapist, a parent or student volunteering to serve on an official committee, such as a disciplinary or grievance committee; or a parent, student, or other volunteer assisting another school official in performing his or her tasks. A school official has a legitimate educational interest if the official needs to review an education record in order to fulfill his or her professional responsibility. Upon request, SPS discloses education records without consent to officials of another school where a student seeks to enroll. Other exceptions under FERPA that permit disclosure without consent are outlined in Superintendent Procedure 3231SP. (4) The right to file a complaint with the U.S. Department of Education concerning alleged failures by SPS to comply with the requirements of FERPA. Written complaints should be directed to Family Policy Compliance Office, U.S. Department of Education, 400 Maryland Avenue S.W., Washington, DC 20202.
Directory Information: Under FERPA, SPS may release “directory” information to anyone, including but not limited to parent-teacher organizations, the media, colleges and universities, the military, youth groups, and scholarship grantors, unless you notify SPS in writing that you do not want the information released. The following information is considered directory information: parent/guardian and student name, home address, home telephone number, home email address, student photograph, student date of birth, dates of enrollment, grade level, enrollment status, degree or award received, major field of study, participation in officially recognized activities and sports teams, height and weight of athletes, most recent school or program attended, and other information that would not generally be considered harmful or an invasion of privacy if disclosed.
Release of Directory Information for Students in Grades Pre-Kindergarten to Eight (Pre-K to 8)
As a parent/guardian of a pre-kindergarten student, an elementary student, or a middle school student you have the right to choose between two (2) options on whether directory information concerning your student is released or not. Please check one box below and return this form to the school your student attends no later than October 1st. If the parent/guardian does not check one of the boxes or does not return this form, SPS considers the lack of response as consent for box A.
Turn Over for Signature and Selection
Revised July 2015 Pre-K to 8 FERPA FORM
For students in grades Pre-Kindergarten through Eight (Pre-K to 8): Pre-K to 8 FERPA FORM ForPlease students mark only in onegrades box: Pre-Kindergarten through Eight (Pre-K to 8): PleaseA. markI consentonly one to box: the release of the above directory information about the student named below. A.B. *I Iconsent do NOT to theconsent release to ofthe the release above of directory the above information directory aboutinformation the student about named the student below. named B. *below,I do NOT except consent as authorized to the release by law. of the above directory information about the student named *If you havebelow, selected except Option as authorized B - No Release by law. of Information - your child's information will not be included in any of the following:
*If you- Yearbook have selected (student's Option photograph B - No Release and nameof Information cannot be -included your child's in the information yearbook) will not be included in any of the following: - Media Release (news media and/or Seattle Public Schools cannot photograph or interview student) - PhotographYearbook (student's (student's photograph photograph and cannot name be cannot posted be on included the school in 'sthe or yearbook) district's website) - VideosMedia Release(no videos (news of student media and/orwill be Seattleposted Publicon the school'sSchools cannotor district's photograph website or) interview student) - SocialPhotograph Media ( s(tudent'sno videos photograph or photographs cannot will be be posted posted on on the the school school's 'sor or district district's 'websites social) media channels) - Videos (no videos of student will be posted on the school's or district's website) - Social Media (no videos or photographs will be posted on the school's or district's social media channels) Notice of Right to File a Public Records Request: Pursuant to RCW 28A.320.160, school districts are required to notify parents/guardians that they have the right, under the Washington Public Records Notice of Right to File a Public Records Request: Act (RCW 42.56), to request the public records regarding school employee discipline. To file a public records request with SPS, send a written request, Pursuantin writing, to to: RCW Office 28A.320.160, of the General school Counsel: districts Attn: are Publicrequired Records to notify Request; parents/guardians SPS: MS 32-151; that they PO Boxhave 34165: the right, Seattle, under WA the 98124, Washington or fax Publicyour request Records to Act(206) (RCW 252-0111. 42.56), to request the public records regarding school employee discipline. To file a public records request with SPS, send a written request, in writing, to: Office of the General Counsel: Attn: Public Records Request; SPS: MS 32-151; PO Box 34165: Seattle, WA 98124, or fax your request to (206) 252-0111.
______PRINT Student's Full Name ______Date of Birth ______Student’s School ID number PRINT Student's Full Name Date of Birth Student’s School ID number ______PRINT Signer’s Full Name ______PRINT Signer’s Full Name ______Date ______Parent/Guardian/Eligible Student’s Signature ______Date Parent/Guardian/EligiblePLEASE Student’s RETURN Signature THIS FORM DIRECTLY TO THE STUDENT’S SCHOOL EITHER IN PERSON OR BY U.S. MAIL. PLEASE RETURN THIS FORM DIRECTLY TO THE STUDENT’S SCHOOL EITHER IN PERSON OR BY U.S. MAIL. If you have more than one student, you must return a separate form for each student to each student’s school. If you have more than one student, you must return a separate form for each student to each student’s school.
Revised July 2015 Revised July 2015 PRINT CHILD’S NAME ROOM # BUS #
NAMES OF SIBLINGS AT SAME SCHOOL
Emergency Information & Student Release Form
PARENT NAME HOME PHONE In the event of an emergency that would keep my child at school for an extended period of time, I want school staff to know that my child has the following medical WORK PHONE CELL PHONE condition(s) and needs the following medication(s): MEDICAL CONDITIONS/ALLERGIES E-MAIL ADDRESS
ADDRESS MEDICATION(S)
PARENT NAME HOME PHONE TIME OF DAY TAKEN
WORK PHONE CELL PHONE
(Provide 72 hours of essential medication and complete E-MAIL ADDRESS required Authorization for Medications form.)
ADDRESS
Emergency Medical Release EMERGENCY CONTACT (LOCAL) HOME PHONE
IN THE EVENT OF AN INJURY TO MY CHILD CAUSED BY AN WORK PHONE CELL PHONE ACCIDENT OR A NATURAL DISASTER, such as an earthquake, i understand that it may not be possible to contact me. It is my intent and understanding that this medical release will I also give school staff permission to release my child to be used only when attempts to reach me have failed. I, the following guardians/neighbors in an emergency: PRINT PARENT/GUARDIAN NAME
NAME HOME: WORK: The parent/legal guardian of: RELATIONSHIP CELL: PRINT CHILD’S NAME NAME HOME: WORK: RELATIONSHIP CELL: authorize staff of the Seattle School District to refer my NAME HOME: child for all medical care deemed immediately necessary WORK: or advisable by a hospital physician to safeguard my RELATIONSHIP CELL: child’s health. I waive my rights of informed consent to such treatment and authorize a copy of this consent form EMERGENCY CONTACT (OUT OF STATE) HOME PHONE to be treated with the same authority as the original. PARENT/GUARDIAN’S SIGNATURE DATE WORK PHONE CELL PHONE
5IPSOUPO $SFFL t " 4FBUUMF 1VCMJD 4DIPPM t SE "WFOVF /& t 4FBUUMF 8BTIJOHUPO t English DO NOT WRITE IN THE SPACE BELOW – FOR ENROLLMENT OFFICE USE ONLY STUDENT ID# ______SY/SCHOOL# ______/______
STUDENT HEALTH INFORMATION Information on this form is to be filled out (updated) for each new school year. Please complete both sides of this form and return to your school nurse as soon as possible.
Name: ______Birthdate: ______Sex: M / F Last First MI (circle) School: Grade: ______Date: ______
SPECIAL HEALTH CARE PLANNING
If anything checked for SPECIAL HEALTH CARE PLANNING, send form to Health Services (MS 31-650 or call 206-252-0750)
☐Diabetes – Date of diagnosis: ______My student has: ☐ insulin pump ☐ insulin pen ☐ injected insulin
☐Seizure Disorder – My student needs emergency medication for Seizures. Name of medication: ______
☐Special Health Care Planning - My child has special health care needs such as – wheelchair, tube feedings, breathing tube, catheter, intravenous tubes or other. Please describe your child’s condition(s): ______
☐My child has NONE of the health concerns/conditions listed above. LIFE THREATENING CONDITIONS If anything checked for LIFE THREATENING, send form to your child’s school
Asthma *Severe -(If this box is checked, please answer the following questions): Yes ☐No ☐ Does child use rescue inhaler routinely for asthma symptoms? Yes ☐No ☐ Has your child been hospitalized for asthma in the past year? Yes ☐No ☐ Has your child used steroids (prednisone) for asthma symptoms in the past year? (If mild or moderate asthma, see box below ‘Health History -Non-Life Threatening’
Allergy/Anaphylaxis -*Severe, with Epi Pen/ Auvi-Q prescription (for example: food, insect stings) Allergen(s): ______Other: ______
☐My child has NONE of the health concerns/conditions listed above.
ALERT TO PARENTS/GUARDIANS: The school must know of LIFE THREATENING conditions (for example severe allergy with anaphylaxis, diabetes, asthma) prior to the start of school, as these may require an Individualized Health Plan (per RCW 28A.210.320). Contact your School Nurse or Health Services to begin the process for a student health care plan and/or medications at school.
HEALTH CONDITIONS
Check any of these conditions which your child has or has had:
☐ADD/ADHD ☐Blood Disorder ☐Depression/Anxiety ☐Heart Problems ☐Serious Injury ☐Allergies mild or moderate (circle one) ☐ Bowel/Bladder ☐ Dental ☐Orthopedic/Bone ☐Vision Concerns ☐Asthma mild or moderate (circle one) ☐Cancer ☐Hearing ☐Social/Emotional/Behavioral ☐Other If you have checked any of the above medical conditions/concerns, please explain: ______
Has the student ever visited an emergency room or hospital for the medical issue? YES / NO (circle) If yes, date: ______
☐My child has NONE of the health concerns/conditions listed above.
PLEASE SEE OTHER SIDE
SPS – STUDENT HEALTH INFORMATION continued.
MEDICATIONS List any medications taken by student:|
Medication Taken: ______For______☐At Home ☐At School Medication Taken: ______For______☐At Home ☐At School Medication Taken: ______For______☐At Home ☐At School
Students requiring medications during the school day (herbal, over the counter, or prescription) MUST have a written provider order and written parent consent and health care provider must be on file. Contact your school office for MEDICATIONS AT SCHOOL form and MUTUAL EXCHANGE form.
SHARING HEALTH CARE INFORMATION In order to provide a safe and healthy environment for your child, the school nurse may need to share information about your student’s health condition with teachers and essential school staff. If you have questions, please contact your school nurse or Health Services.
CONTACT INFORMATION Please provide correct & current contact numbers, and update with School Nurse if needed.
Name of Health Care Provider: ______Phone: ______
Name of Dentist: ______Phone: ______
1. Parents/Guardians 2. Parents/Guardians Names: Home phone: Cell phone: Work phone: Email: Additional Information:
______Student’s Name
______Your Name (printed) Signature
______Relationship to Student Today’s Date
Nurse Review Date/Initial:______HealthRegFORM0415 Form adapted w/permission BSD&ESD
PRINT CHILD’S NAME ROOM #
Permission for Child to Attend Walking Field Trips
School Year 2015–2016
PRINT child’s NAME
Teacher’s Name Room #
Your classroom teacher may schedule walking field trips throughout the school year. Destinations from Thornton Creek may include View Ridge Park, Wedgwood QFC and Wedgwood Post Office. For intermediate grades, students may also walk to the Northeast branch of the Seattle Public Library or to the Burke Gilman trail by 40th Avenue NE. Students will walk on sidewalks observing signals and crosswalks. In order for your child to participate, we need your consent.
I grant permission for my child to participate in all walking field trips.
PRINT PARENT/GUARDIAN NAME PARENT/GUARDIAN’S SIGNATURE Date
Walking Field Trip Medical Release
PRINT PARENT/GUARDIAN NAME
In case of an emergency, I parent/legal guardian of PRINT child’s NAME
authorize and consent to emergency medical, surgical, hospital care, treatment and procedures deemed immediately necessary by a physician to safeguard my child’s health if I cannot be contacted. I waive my rights of informed consent to such treatment. I also authorize a copy of this consent form to be treated with the same authority as the original.
PRINT PARENT/GUARDIAN NAME PARENT/GUARDIAN’S SIGNATURE Date
Form created April 2014
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300 Every student achieving, everyone accountable McKinney-Vento- Families in Transition
Student Housing Questionnaire 2015-2016
This questionnaire is intended to address the McKinney-Vento Act, 42 Section U.S.C. 11435.
Student name (legal Name):______School______
Parent/Guardian name:______
Please list all of YOUR preschool and school-aged children currently living with you (PLEASE PRINT).
Name: ______Birth Date: ______School:______
Name: ______Birth Date: ______School:______
Name: ______Birth Date: ______School: ______
Your child or children may eligible for additional educational services through Title I, Part A Federal McKinney-Vento Assistance Act. Eligibility can be determined by completing this questionnaire. (Check all that apply in Section A or B)
Section A ____Rent/own my own home *Choices in Section B do not apply
*If parent/guardian has checked this section, completion of this form is not required.
Section B ___Temporarily living with another person due to loss of housing or economic hardship (Doubled Up) ___In a motel or hotel ___In Transitional Housing ___Foster Child Awaiting Placement ___Group Home ___In a shelter ___Unaccompanied Youth not in the physical custody of parent/legal guardian ___Unsheltered (living in a vehicle of any kind, park, campground, without running water/electricity or substandard housing).
ADDRESS OF CURRENT RESIDENCE:______
NAME OF MOTEL/SHELTER OF CURRENT RESIDENCE: ______
SIGNATURE of Parent /Legal Guardian: ______Date:______
*For School Staff Only: Forward completed questionnaire to the McKinney-Vento Liaison, Families in Transition Program, at Mail Stop 22-938. You may also scan this document and send it to [email protected].
(Updated 8/15) PRINT Parent Name
2015–2016 Parent Mandatory Forms / Required Documents
PLEASE COMPLETE ONE PARENT FORMS: COPY OF EACH FORM FOR EACH PARENT. THE FOLLOWING ARE REQUIRED FORMS OR TRAININGS THAT MUST BE COMPLETED BY EACH PARENT AND RETURNED WITHIN THE FIRST WEEK OF Please check each box on this SCHOOL. PARENTS WILL NOT BE ALLOWED TO VOLUNTEER IN CLASSROOMS check list (as you complete OR CHAPERONE FIELD TRIPS UNTIL THESE FORMS ARE RETURNED. each form) to ensure that you return a complete packet. o Volunteer Screening Form + Photocopy of your driver’s license Please print double sided if possible. A copy of your driver’s license is required.
o Volunteer Application
o Volunteer Agreement and Handbook Please sign the Agreement after reading the handbook available online at: http://www.seattleschools.org/UserFiles/Servers/Server_543/File/ Migration/How%20do%20I/volunteer%20Hand%20Book%202013. pdf. Hard copies of the handbook are available for you to read in the office; agreement forms are also available for you to sign and turn in.
o Adult Sexual Misconduct Online Training Follow this link to the training video: http://www.seattleschools.org/cms/ One.aspx?portalId=627&pageId=18626. Print and turn in your completed certificate. If you have completed this training previously, you do not need to do it again. Full instructions can be found in this packet.
Go uidelines for Volunteer Field Trip Chaperones
o Volunteer Driver Checklist
o Volunteer Survey You can print this form double-sided.
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300 Seattle Public Schools-Screening Form Request for Criminal History Information Child / Adult Abuse Information Act RCW 43.43.830 through 43.43.845
Seattle Public Schools
School Site or Program: ______
Volunteers: Please return this form to the school or program.
The Washington State Legislature has helped us assure security for children by allowing background checks on all people who work with children in schools. The Seattle School District supports this requirement. Because we care about our students, all volunteers must complete this form and undergo a background check prior to beginning as an active volunteer, yearly.
APPLICANT OF INQUIRY
First Name ______MI ____ Last Name ______Aliases / Maiden Name ______Date of Birth ______Gender ______Address ______City / State / Zip ______E-mail ______Phone Number(s) ______Applicant Signature ______Date ______Name of child in school, if any______
See Reverse for Disclosure Statement
School Verification ID Verification (Driver’s License or other ID with name and birth date) ...... Initials ______ Address Verification for overnight chaperones is required: (Driver’s License or other ID with name and date) ...... Initials...... OK WATCH (State Patrol Criminal History Check) ...... Date Passed ______Initials ...... Comments ______
Building or Program Site Administrator approval: ______date______
Revised: January 24. 2014 Page 1 of 2
In accordance with Chapter 43.43 RCW, prospective volunteers are required to complete this disclosure form. In addition, prospective volunteers are required to complete the questions below.
Volunteer Applicant Disclosure Form Answer YES or NO to each of the listed items. If the answer is YES to any of the items, please explain in the area provided, indicating the charge or finding, the date and the court(s) involved.
(1) Have you in the past year, been arrested for any crimes? Answer ______If yes, please explain:
(2) Have you been convicted of any crimes? Answer ______If yes, please explain:
(3) Have you been found in any dependency action under Chapter 13.34 RCW to have sexually assaulted or exploited any minor or to have physically abused any minor? Answer ______If yes, please explain:
(4) Have you been found by a court in a domestic relations proceeding under Title 26 RCW to have sexually assaulted or exploited any minor or to have physically abused any minor? Answer ______If yes, please explain:
(5) Have you been found in any disciplinary board final decision to have sexually abused or exploited any minor or to have physically abused any minor? Answer ______If yes, please explain:
(6) Other than any matter above, is there any fact or circumstance involving you and your background that would call into question you’re being entrusted with the supervision, guidance and care of young people, vulnerable adults or developmentally disabled persons? Answer ______If yes, please explain:
(7) All volunteer chaperones participating in overnight field trips may be required to submit to a FBI background check. Have you fully disclosed any information that may prevent you from volunteering? Answer______If no, please explain:
I have read the information contained in this application. Pursuant to RCW 9A.72.085, I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I authorize Seattle School District #1 to conduct a background check and to obtain any and all information needed to process my volunteer application. I further authorize any person contacted by the Seattle School District to provide information to the Seattle School District about my volunteer application. I understand that information from others will not be made available to me. I hereby release and hold harmless Seattle School District #1 and all references from any and all liability in obtaining or disclosing such information about my background. I understand that the District may, at its discretion, exclude me from volunteering for any reason, including any misleading or incomplete statements on this application. Failure to answer any truthfully will automatically disqualify you from volunteer and employment opportunities with Seattle Public Schools.
Volunteer Applicant Signature ______Date ______
Page 2 of 2 To be completed by applicant and to be approved by the building administrator or program manager
Volunteer Application Form
Name______Student name ______Address______Phone (home) ______(work/cellular) ______E-mail (optional) ______Date of Birth______Emergency Contact: Name ______Phone______Relationship ______Do you require any special accommodations in a work environment? Yes No If yes, please describe. ______Please indicate what type of volunteer opportunity you are seeking:
___Overnight Field trip Chaperone* ___ Academic assistance (i.e. one-to-one tutor, small group support, classroom assistance) ___ Curriculum enrichment (i.e. drama, arts & crafts, music) ___ Working with Special Populations (i.e. Special Education, English as a Second Language, gifted students) ___ Clerical / Non Academic Support (i.e. lunchroom or playground supervision, office support, library support) ___ Administrative ___Coaches of athletic middle and high school must be fingerprinted according to Board policy ___Paid Activity Instructor
In order to make an effective match for you, it is important for us to know of any special skills or talents you would like to bring to your volunteer work. If so, please describe. (Use reverse side if needed):
Is there a particular classroom, project or department you are interested in supporting? If so, please indicate: ______
Please indicate what days and times you have available: Volunteer purpose: Day (or days) ______community organization Optimal time ______academic requirement
Please submit this form to the school/department where it will be kept on file.
I understand that before I am allowed to volunteer in a school, that I must fill out a SPS Screening form Request for Criminal History Information and that a background check will be performed by Seattle Public Schools. I also understand that volunteering at a school or in a program with students, is a privilege and that the Building Principal or Program Manager can end a person’s ability to volunteer at any time.
______Signature of Volunteer Date
* All volunteer chaperones participating in overnight field trips must provide verification of two years continuous residence to their volunteer coordinator (DL, insurance doc., property tax statement, employment...). Seattle Public Schools Volunteer Handbook revised: January 2014
Volunteer Management Department Seattle Public Schools Volunteer Handbook
VOLUNTEER AGREEMENT
Safety and Liability Issues
_____ As the relationship with a student progresses, he/she will begin to trust you and may start to confide in you. You should take time to listen and show them that you care about them. However, do not make a promise you cannot keep. If a student reveals information relating to a possible abuse or neglect situation, let the student know that you care and are there to listen but that you are required to pass this information on to a teacher, counselor, or principal who can offer them help
_____ Personal information about yourself should be shared only as it is relevant to the work you are doing with the student. Do no give personal contact information such as your address, phone, personal website, and email.
_____ Some students, especially at the elementary level, will naturally become attached and show affection. Students may crave affection and attention, so it is important that you handle the situation with sensitivity. Front hugs should be avoided. Instead, carefully put your arm around a child’s shoulder and turn it into a side hug. Use other signs of support, such as “high fives.” In addition, regardless of age, students should never sit on your lap.
Working with Children from Diverse Cultural Backgrounds
_____ Students in Seattle Public Schools come from many different families, cultures, and communities--each with its own set of values and beliefs. Our individual culture, beliefs, values and behaviors seem so naturally a part of which we are that it is often challenging to understand others with unique traditions. Understanding the students’ cultures and helping them to understand the school culture will increase your ability to help them learn.
Confidentiality
_____ Students in Seattle Public Schools have the right to expect that information about them will be kept confidential by all volunteers. Additionally, the U.S. congress has addressed the privacy-related concerns of educators, parents, and students by enacting the Family Educational Rights and Privacy Act (known more commonly as “FERPA” or the “Buckley Amendment”).
VMD: 1/2014 pg. 18
Seattle Public Schools Volunteer Handbook revised: January 2014
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.
Volunteer Management Department Seattle Public Schools Volunteer Handbook
even with others who are genuinely interested in the student’s welfare, such as social workers, scout leaders, clergy, grandparents, or nurses/physicians. A grave medical emergency, in which confidential information may be necessary for a student’s care, is an 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.
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.
isn’t just impolite, it’s against the law.
Agreement I, (print name) ______, as a volunteer have read and agree to the above terms. In addition to the remaining guidelines in the Volunteer Handbook, I have been made aware of where to find the Volunteer Handbook and to whom I can speak to regarding any questions or concerns I may have.
______Please print full name Volunteer site
______Please sign full name Date
______Volunteer Coordinators signature Date
VMD: 1/2014 pg. 19
PRINT Parent Name
Adult Sexual Misconduct Prevention: Online Training for Volunteers
The training can be found on www.seattleschools.org website under Families & Communities—Volunteering at SPS; see fourth item under Volunteering Check List. Or for those reading this on their computer, click here: http://www.seattleschools.org/cms/One.aspx?portalId=627&pageId=18626.
The School Community’s Role in Prevention and Response
Overview: This training will provide volunteers and community partners with information about sexual misconduct as well as guidance on appropriate adult/student interaction.
All volunteers are required to complete this online course.
Instructions: n This course should take about 25 minutes to complete. n This course requires Flash Player 10.2 or newer. If you have trouble seeing the videos you may need to update your browser. Click here to check if Flash Player is installed on your computer. n For best results use Chrome. n This program contains videos that play best on a fast connection. Wi-Fi may be too slow. If you have trouble getting the videos to load you may be able to use a school computer. Please check-in with the school staff to assist you. n When you complete the course, you will be asked to enter your name, school, etc. n When you hit “submit” you will see a confirmation message that your information has been entered into our database. n If you would like a digital certificate, please take a screenshot. You may be able to “save as file” through your printer interface. Save your digital copy as PDF or .jpg (JPEG) format only.
Start the online training course (not available for mobile devices yet. This course works best in Chrome)
If you have questions about course content or requirements, please email: [email protected]. Please report any technical issues to [email protected]. Please note your computer type, browser and be as specific as possible so that we can address the issue ASAP.
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300 PRINT Parent Name
Guidelines for Volunteer Field Trip Chaperones
Thank You for Your Support! 1. All school rules apply on District-sponsored events. Seattle Public Schools believes that field trips provide a Chaperones are expected to comply with District policies, valuable educational experience for students. Without the follow the directions given by the District’s coordinating help of volunteer chaperones like you, many field trips staff member, work cooperatively with other staff and would not be possible. We thank you very much for giving volunteers, and model appropriate behaviors for students. your time and support to these important activities. In order to help ensure that District-sponsored field 2. In order to comply with District policy, during trips result in safe and rewarding experiences for all District sponsored events, chaperones: participants, we have prepared these guidelines to provide • may not use, sell, provide, possess, or be information about volunteering as a field trip chaperone. under the influence of drugs or alcohol • may not use tobacco in the presence of, Becoming a Volunteer Field Trip Chaperone or within the sight of, students Because student safety is our paramount concern, • may not possess any weapon Washington State law requires the District to conduct a • may not administer any medications, criminal record background check of school volunteers prescription or nonprescription, to students with unsupervised access to children. To accomplish this, all volunteers must complete the following form yearly: 3. Students must be supervised at all times while at District-sponsored events. As a chaperone, you will o Seattle Public Schools Screening Form/ supervise a small group of students, helping them learn Request for Criminal History Information and making sure they behave appropriately. Students must stay with you, their chaperone, at all times. Go The District also requires that volunteer over use of the buddy system with students under your chaperones be at least 21 years old. care. Account for all participants regularly and before changing activities. Be sure you know when and where to meet the rest of your group at the end of the visit. Guidelines for Volunteer Chaperones Chaperones must be readily available, be mindful of Prior to your field trip, the coordinating staff member safety concerns, and respond to students’ needs. will provide you with information regarding the activities planned for the trip, expectations for supervising students, 4. Student behavior is your responsibility. School and emergency procedures. In addition, we have developed rules related to student behavior apply. Go over the following general guidelines to help you perform your rules and standards of behavior, safety rules, and duties as a chaperone. If you have any questions regarding any site specific rules with students. Ensure that these guidelines, please contact the coordinating staff students do not get involved in any extra activities member or the building principal/program manager. not pre-approved by administrators and parents. continued on next page
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300 PRINT Parent Name
Guidelines for Volunteer Field Trip Chaperones, continued
continued from previous page In the event that I have a personal 5. Eating and drinking are not permitted outside of emergency, please contact: designated areas and predetermined times. Printed Name 6. For the protection of both the student and the chaperone, chaperones should not place themselves Relationship in situations in which they are alone with a student.
7. Family members or friends of a chaperone may not Daytime Phone participate in a District-sponsored field trip or event unless prior approval has been obtained from the building principal. Additional small children can distract you from your duties as a chaperone.
8. Chaperones who transport students in their personal vehicle must complete the Volunteer Driver Checklist Acknowledgement form. You are expected to comply with all District and State student transportation rules and regulations. Be I acknowledge that I have received the copy of the aware that your personal vehicle insurance provides “Guidelines for Volunteer Field Trip Chaperones,” primary coverage in the event of an accident or injury. have read these guidelines, and agree to comply with the guidelines as a school volunteer. 9. Be sure to know what to do in an emergency (medical emergency, natural emergency, lost child, serious Print Parent/Guardian Name breach of rule, etc.). Know who is first aid trained, where the first aid kit is, where the cell phone is kept, and Parent/Guardian’s Signature * Date who has the copies of parental permission slips with emergency phone numbers and medical information.
Chaperone Guidelines 070825
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300 Driver Name
SEATTLE PUBLIC SCHOOLS VOLUNTEER DRIVER CHECKLIST
TRIP INFORMATION
DATE: ______Various SCHOOL: ______Thornton Creek School
PURPOSE OF TRIP: ______Class Field Work
DATE OF TRIP: ______Various dates throughout the 2015–16 school year ______
TRIP IS TO: ______Field work locations (see Field Trip Permission Form)
FROM: ______Thornton Creek School
* MAXIMUM #. OF STUDENTS TO BE TRANSPORTED IN VOLUNTEER’S VEHICLE:______*
DRIVER SCREENING/INSURANCE REQUIREMENTS
* NAME OF DRIVER: ______
* VEHICLE YEAR/MAKE/MODEL: ______* LIC #: ______
Please respond to each item with a yes or no answer.
YES/NO Check “Yes” below if statement is true for you.
* ______I am older than 21 years of age.
* ______I have a valid Washington State driver's license.
* License #: ______* Exp. Date:______
* ______I have had no vehicle moving violations or at-fault accidents within the last three years. If you have had any, please list: ______
* ______I carry minimum auto liability limits of $300,000 combined single limit of liability (or $100,000/$300,000 Bodily Injury; $50,000 Property Damage) and uninsured/underinsured motorist coverage.
* Company: ______* Policy #: ______
* ______I am aware that, in the event of an accident while on a school-related activity, any claims will be tendered to my personal automobile insurance company, and my insurance is primary.
(Continued on reverse side) * All asterisked items are required.
Volunteer Driver Checklist.doc 05/05/14 Driver Name
VOLUNTEER DRIVER CHECKLIST
VEHICLE INSPECTION
Please respond to each item with a yes or no answer. YES/NO
* ______There is a working seat belt for the driver and age-appropriate passenger restraints for each passenger, and I enforce the use of passenger restraints by all occupants of my vehicle.
* ______My vehicle's brakes, including the emergency brake, are in good working order.
* ______My vehicle's tires have legal tread depth (at least 3/32").
* ______My vehicle's brake lights, turn indicators, and headlights are in good working order.
* ______My vehicle's windows are clear and provide an unobstructed view for the driver.
* ______My vehicle has functioning rear view mirrors (center and left side).
* ______My vehicle has no other physical defects that would interfere with the safety of the driver and passengers.
* ______My vehicle has a rated capacity of ten passengers or less.
* ______If my vehicle has dual airbags, I will not seat children under 13 or small persons in front passenger seat.
* ______I will not transport students in a motor home, fifth-wheel trailer, cargo compartment of a van or truck bed.
The above information is true and accurate to the best of my knowledge. I hereby give my permission for a copy of my personal Motor Vehicle Report to be ordered and used in consideration of my transporting students during field trips.
* ______*______Signature of Volunteer Driver Date
*****************************************************************************************
ADMINISTRATIVE REVIEW
______If the volunteer will drive for more than one day, the district has obtained the information to order a motor vehicle abstract (three-year comprehensive record) from the Department of Licensing.
______If the volunteer will have unsupervised student contact, the district has obtained the information to order a Washington State Patrol background information check.
______All students have parental permission to ride with a volunteer driver.
______All "NO" responses have been addressed satisfactorily.
I have reviewed the above information and this driver and vehicle are approved for this trip.
______Signature of Administrator/Designee Date
PRINT Parent Name
2015–2016 Volunteer Survey (Please complete one per Parent)
The purpose of the Volunteer Survey is to assess Special Events your volunteer interests outside of classroom help. Your teacher and room parent will be organizing in- Please indicate which of the following special events class volunteers and contacting you directly about interest you. Keep in mind that there are a number those opportunities. of ways you can help out with certain events. Many Please remember this survey is only intended for events require lots of pre-planning which can be done from home, some during nights and weekends. you to indicate your interest in an activity and to request more information. You are not making a o School Sept. 30, 2015 Volunteers are on site commitment by checking boxes. Pictures during the school day. o W alkATHON Oct. 8, 2015 Volunteers are on site during the school day with some at home prep. Please enter your contact information o Vision November TBD Volunteers are on site Screening during the school day Parent Name o Pies for Staff November TBD Bring a delicious pie for our wonderful staff Home Phone o Fall Book Fair Dec. 4–7, 2015 Various opportunities at University at home, during the Book Store school day and on site E-mail Address o Winter Bazaar Dec. 11, 2015 Various opportunities, some in the evening o School Tours January– Helping with tours or Please list your student(s) here March assisting with child care o Tsalent Night Feb. 5, 2016 Opportunities to help Student Last Name First Name Rm with rehearsals and night of the event Suchool A ction March 25, 2016 Many different ways to Student Last Name First Name Rm o help from home, in the evening and at the event Student Last Name First Name Rm o N ew FaMILY June 1, 2016 Assist with tours the Orientation evening of the event o Spring May 16–19, Help with planning and Student Last Name First Name Rm Book Fair 2016 on site during the event o A thleTIC Skills May 19, 2016 Help with rehearsals, Night and display of art and Art Show night of the event I am available to volunteer (check all that apply) o Fyield Da June 15, 2016 Help during the school o day time, on-site o day time, off-site o weekends day at an event station o evenin gs, on-site o evenin gs, off-site o YearBook June Opportunities to help from distribution home throughout the year. o Iol will be v unteering for my spouse/family member. please indicate name:
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300 PRINT CHILD’S NAME ROOM # School day assistance Your Special skills & Interests
Your classroom teacher and room parent will be organizing Sometimes, the need for a particular skill arises. in-class volunteers. Here are some other ways you can Would you be interested in helping out if any of the help out regularly during the school day outside the following were needed? Yes, I have experience in: classroom. Please select areas that interest you. o Cyarpentr o Publishing o Lunchroom Help Nova serve lunch and o Laandsc ping o Project Management supervise kids during lunch o Public Relations o Sales and Marketing o Recess Get some fresh air and help kids stay safe and have fun o Photography o Theater o Library Shelving, check-out and much more o Video o Catering o Bikes & Skates Help Sue help our kids learn these skills in PE o Sustainable Gardening o Web Development o Self-Contained Non-room parents are very welcome o Graphic Design o N ewsletters Classrooms o Office Help Jenny in the office Assistance If you haven’t seen an opportunity that calls out to you or fits your schedule, please let us know your o Selling Scrip Before- and after-school opportunities volunteering interests or skills you have to offer, and o Art Room Help Maria in the art room we will be in touch to help you get connected. Assistance and with hanging work o Laandsc ping Many opportunities during non-school hours
Site Council Positions (please check any that interest you.)
Looking for ways to participate in a leadership role? Here are some open positions to consider. o Vice Chair
o Secretary o Curriculum o Communications o Diversity o Grants o Safety
The Thornton Creek Site Council always welcomes new Please provide your contact information again, members to its committees. Following is a list of committees. in case these pages become separated. Thanks! Please select any committee(s) that interest you. Name o Finance o Safety o Communications o Curriculum Home Phone o District Relations o Recruitment and Hiring E-mail o Diversity o Hospitality o Facilities o Grant Writing o Safety / Emergency o Volunteer Coordination Preparedness
Please return your completed survey, along with the other volunteer forms and certificate indicating completion of the online training, to the school office. Thank you!
Thornton Creek • A Seattle Public School • 7711 43rd Avenue NE • Seattle, Washington 98115 • (206) 252-5300