IGE-E - School Volunteer Registration

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SECTION I: INSTRUCTIONAL PROGRAM

File IGE-E

PORTAGE LA PRAIRIE SCHOOL DIVISION

535-3rd Street N.W., Portage la Prairie, Manitoba R1N 2C4

Telephone (204) 857-8756 Fax (204) 239-5998

SCHOOL VOLUNTEER REGISTRATION

(To be completed by all school volunteers)

SCHOOL ____________________________________

SURNAME ___________________________________ GIVEN NAMES ______________________________

ADDRESS ___________________________________ POSTAL CODE _____________________________

PHONE NO. __________________________________ ____________________________________________

Residence Business

HAVE YOU VOLUNTEERED PREVIOUSLY, IF SO, WHERE AND IN WHAT AREAS?

____________________________________________________________________________________________

AREAS OF INTEREST: ( E.g., office work; classroom helper; coaching; supervising field trips, etc.)

____________________________________________________________________________________________

SPECIAL SKILLS/TRAINING: (E.g., second language; music; art; coaching certificate, nursing, etc.)

____________________________________________________________________________________________

TO BE COMPLETED BY VOLUNTEERS WORKING WITH STUDENTS UNDER SPECIAL CIRCUMSTANCES

If you are working with or supervising students independently, e.g. coaching, assisting students in isolated locations, supervising students on extended field trips, or helping in other situations outside of the immediate supervision of staff,Board Policy requires the completion of :

1. A Provincial Child Abuse Registry form (attached)

2. A Criminal Record Check (attached)

3. Reference Checks

CHARACTER REFERENCES: (please list the name and phone number of two references)

Name	Phone Number	Comments (for office use only)
1)
2)

DATE: ___________________________________ SIGNATURE: _________________________________

* Principals need to complete the information on the back of this form.

AG 43-98/09

This Volunteer Registration Form is to be kept on file at the school.

I hereby verify that the following checks have been completed:	Comments:
1. Reference Check
2. Provincial Child Abuse Check (attached)
3. Criminal Record Check (attached)
4. Holds a valid driver’s licence

If any of the above checks have not been completed, please explain in the comment section.

__________________________________________ ______________________

Principal’s Signature Date

"Dedicated to the Pursuit of Excellence"