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LEVEL II: Volunteer at Mason City Schools This form applies to anyone who is serving as an extension of our staff by either responsibility or frequency of attendance and where there is opportunity to be alone or out of line of sight with student (i.e. accompanying a school group on a day trip or volunteering in the school building) In order to serve as a volunteer in one of the above capacities, you must agree to release information to the district for the purpose of a criminal background check. Please complete the following form to be cleared for volunteering with the district. VOLUNTEER RELEASE FORM • I agree to abide by all relevant board policy and administrative guidelines while on duty for the district • I understand that, although I am covered under the district liability insurance policy, I am not covered by a health insurance policy nor am I eligible for worker's compensation. • I understand further that, as a volunteer, I am not in any matter considered an employee of the district or entitled to any benefits provided to employees. I further release the Board of Education from any and all liability for damages, whatever their nature, which may result as a consequence of my volunteer services. • All volunteers need to display appropriate behavior at all times. DUTY TO MAINTAIN CONFIDENTIALITY OF STUDENT RECORDS AND INFORMATION The district is committed to maintaining the security and confidentiality of all student records and/or student personally identifiable information. As an approved volunteer in the district, you may have access to student records and/or student personally identifiable information that must be maintained as confidential and not released and/or permitted access to except as authorized by Board policy and law. Violations of this duty may result in a reassignment and/or restriction of your volunteer responsibilities by the building principal or designee. VOLUNTEERS MUST COMPLY WITH THE FOLLOWING: • All Student Records are considered confidential. • Directory information including the student's name, address, telephone number, date and place of birth, major field of study, participation in officially-recognized activities and sports, weight and height of members of athletic teams, dates of attendance, degrees and awards received and previous educational agencies or institutions attended, can only be shared with administrative approval. • Records may not be left in a place where they can be viewed by others. • Copies of records may only be shared with administrative approval. Volunteers may not discuss or repeat information overheard while in the staff lounge, classrooms, offices, school grounds, hallways, school or extracurricular activities. • Volunteers may not discuss information obtained while in a classroom, such as a student's grade or behavior, with anyone other than the student's teacher or the building principal. Concerns or questions regarding the student's records or issues of confidentiality should be brought to the attention of the staff member responsible for supervising your activities and/or building principal. • Any knowledge of a violation of these provisions must be immediately reported to the staff member responsible for supervising your activities and or the building principal. By completing the form, you acknowledge that you have read, understand, and agree to comply with the terms and conditions set forth above. DISQUALIFYING OFFENSES I hereby state that I have not been convicted of any of the following offenses, which make me ineligible to volunteer in a school setting: • sexually-oriented offenses (including rape, sexual battery, unlawful sexual conduct with a minor, gross sexual imposition, sexual imposition, importuning, prostitution, procuring, disseminating matter harmful to juveniles, pandering obscenity or sexually-oriented matter, felonious sexual penetration, illegal use of a minor in nudity-oriented material or performance) • child-related violent offenses (including kidnapping, abduction, criminal child enticement, interference of custody, child stealing, endangering children) • violent offenses (including aggravated murder, murder, voluntary or involuntary manslaughter, vehicular manslaughter and assault, terrorism) • domestic violence If I am arrested or convicted of any of the above offences, I will notify the building principal immediately.

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