Annual Returning Volunteer Verification / Authorization Form - Step 1 of 2

Instructions:

This form should only be completed if you have performed volunteer services on behalf of the Rockford Park District during the preceding 12 months. If you have NOT performed volunteer services during the preceding 12 months, you must complete a New Volunteer Packet.

*

*
*

Except as otherwise instructed, please review and check each box below:

I understand that as a volunteer with the Rockford Park District, a criminal background check will be conducted during any calendar year in which I perform volunteer services. I consent to the Rockford Park District obtaining my criminal conviction history from resources selected by the Rockford Park District.


I confirm that the current information that I previously provided in the "Volunteer Information Form" that I completed and that is on file with the Rockford Park District is accurate and has not changed.


I confirm that I have not been convicted of a crime (other than a minor traffic violation) within the past 12 months.


Please check this box only if your volunteer duties include operating a licensed motor vehicle (this includes tractors and bobcats). By signing this Agreement, I consent to the District obtaining a Drivers Abstract on me from the Illinois Secretary of State.


I understand that I am a Mandated Reporter under the Illinois Abused and Neglected Child Reporting as a volunteer for the Rockford Park District and that I have previously signed a form confirming that status. Therefore, I acknowledge that I am required to report suspected child abuse and/or neglect when I have reasonable cause to believe that a child known to me in my volunteer capacity may be abused or neglected.


I acknowledge that I have previously signed a "Volunteer Waiver and Release Form" that I have submitted to the District; in submitting this Returning Volunteer Form, I confirm that the understandings set forth in the "Volunteer Waiver and Release Form" (including, but not limited to, the warning of risk, waiver and release of claims and assumption of risks) remain in full force and effect.



TERMS OF ACCEPTANCE and SIGNATURE

I, the applicant for this volunteer opportunity, warrant the truthfulness of the information provided in this application.

Please re-type your First and Last Name in the box below. Please be advised, that entering your name in the box below constitutes a legal signature confirming that you acknowledge and agree to the above Statements and the Terms of Acceptance.

* If you are under the age of 18 you will need your parent/guardian to authorize this form.

Parent / Guardian of Minor: First and Last Name:

Parent / Guardian Phone # (we will ONLY use this for contacting you in regards to your minor's application / volunteer activities, or in case of emergency)