SMN High School Profile/Waiver Forms

Youth Volunteer Corps In-School Program Profile and Waiver

THIS IS A LEGAL DOCUMENT. PLEASE READ CAREFULLY.
Please note, this information is kept confidential and is collected for anonymous grant reporting and program improvement purposes only.

For Students:

* Indicates required field

full Name *

First

Last

First Name Last Name

Gender *

Male Female Prefer to self-describe

If you chose 'Prefer to self-describe' and would like to specify, please do so below: *

Date of Birth (MM/DD/YYYY) *

Age *

Grade *

Youth may specify here *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Youth's Phone Number *

Youth's Email *

School *

This information assists us in receiving funding to cover scholarships. This information is kept CONFIDENTIAL.

Qualifies for free or reduced school lunch, or enrolled in a school where the majority of students are eligible for free or reduced lunch
Completing court-ordered service or is a former juvenile offender
Living with a disability
Not currently enrolled in school
At risk to leave high school without graduating
In or aging out of foster care
Has limited English proficiency
Homeless or has run away from home

If you meet any of the following criteria, check this box *

I meet one or more of the following criteria

Youth Agreement
Youth volunteer agrees:

To be on time and work all scheduled project hours OR notify YVC in advance if you cannot.
To maintain a positive attitude and show respect to everyone at the project.
To attend any required orientation and training and to participate in all project activities, including games.
To abstain from profanity, drugs, tobacco, alcohol, sexual activity or violence of any form on projects.
To keep all personal electronic devices off and out of sight during YVC activities.

YVC agrees:

To treat the youth volunteer with respect.
To provide the youth volunteer with appropriate duties that match his or her experience and interests when possible.
To provide trained, screened adult team leaders to guide and assist the youth volunteer on projects.
To provide orientation, training, and evaluation for the youth volunteer as needed.
To recognize the efforts of the youth volunteer and provide confirmation of service hours upon request.

I agree to the terms and conditions *

Yes

By checking the box you acknowledge that you have read and understand this waiver, agree to its provisions, affirm that you are the parent/legal guardian of the child named above, and verify all the information you have given is correct.

Submit

Shawnee Mission North High In-School Waiver.

Youth Volunteer Corps In-School Program Profile and Waiver

Address

Telephone

Email