<p> Sierra Nevada Academy Charter School Volunteer Application Applicant Information Volunteer Last Name: ______Volunteer First Name: ______Physical Address: ______City: ______State: ____ Zip: ______Date of Birth: ______Student’s Name (s): ______Home Phone: ______Cell Phone: ______Work Phone: ______Ethnic Code (Circle 1) 1 – American Indian (Alaskan Native) 2 – Asian/Pacific Islander 3 – Hispanic 4 - Black/African American 5- Caucasian 6 – Mixed Ethnicity Emergency Contact Information Emergency Contact Last Name: ______Emergency Contact First Name: ______Physical Address: ______City: ______State: ____ Zip: ______Phone Number: ______Describe Acquaintance: ______Emergency Contact Last Name: ______Emergency Contact First Name: ______Physical Address: ______City: ______State: ____ Zip: ______Phone Number: ______Describe Acquaintance: ______Health Information Any Known Allergies: ______Any Known Medications: ______Preferred Hospital: ______Insurance Carrier: ______Insurance Group ID: ______Insurance ID: ______Please describe any other health related information that we should know in the event of an emergency: ______References (2) Reference Last Name: ______Reference First Name: ______Physical Address: ______City: ______State: ____ Zip: ______Phone Number: ______Describe Acquaintance: ______Reference Last Name: ______Reference First Name: ______Physical Address: ______City: ______State: ____ Zip: ______Phone Number: ______Describe Acquaintance: ______Volunteer Interests Please describe your interests & abilities in volunteering: _____ Classroom Helper _____ Front Office Reception _____ Curriculum Support (making kits, etc.) _____ ELOB Days Helpers (See list) _____ Nutrition & Kitchen Helper _____ Event Helper (organizing, gathering supplies) _____ Crosswalk Duty AM & PM _____ Fundraising Helper _____ Recess Duty Monitor Helper _____ AR Case (Fridays) _____ Safety Patrol AM & PM _____ Testing Support (Renaissance & Map Test Proctor Asst.) _____ School Store AM, Recess, & PM _____ Reading Helper _____ Landscaping _____ Computer Helper (various technology projects & comp. support) _____ Grounds & Maintenance _____ Donation Acquisition Helper _____ Professional Services (DJ, Catering, Etc.) _____ Community Support _____ Playground Beautification _____ Walking/Running Path _____ Trade (Plumbing, Electrical, etc.) _____ Other (Please describe) Attests _____ I understand that I must follow all school rules as described in the Parent & Student Handbook & the Family Engagement Program Handbook. _____ I understand that I must defer all discipline and behavior-related issues to the teacher to handle. I am not permitted to handle such issues. _____ I understand that I must notify school administration immediately if there is anything that may impede my volunteer status. ______I understand that I must be under the direct supervision of a SNACS school staff member at all times on campus. ______I understand that my volunteer role is a privilege and I will treat it as such. Sierra Nevada Academy Charter School Volunteer Application ______I understand that the school administrators have the right and authority to refuse my volunteerism at any time they determine it is warranted. _____ I understand that I am expected to provide a minimum of 10 hours per family per student each month. _____ I understand that I am expected to maintain a positive attitude at all times on school grounds. I will address any concerns that I have with a SNACS staff member (whenever possible) in private and at a convenient time for both parties. _____ I understand that I may be privy to information under the FERPA laws as a direct result of my volunteerism. I understand that any information I may be exposed to will remain private and confidential. ______Volunteer Signature Date SNACS Office Team Signature Date</p>