Dear Chaperone,
Thank you for your willingness to be a part of this activity. Many of our school’s activities would not be possible, if not for parents and community members who volunteer to ensure the safety of our students and educational value of our activities.
To help ensure the safety of our students, it is necessary to clearly define the expectations that we have for our chaperones. While these expectations are not intended to limit your personal freedoms, the safety and education of our students must take precedence.
Conduct:
-No inappropriate language, jokes, suggestions, or gestures.
-Do not take a picture, video, or record students in any fashion, other then your own child.
-Do not be alone with a student in an isolated area (for example: being alone with a student in a hotel room).
-Do not take ANY substance that may impair your judgment (for example: alcohol, medication).
-Follow all local, state and federal laws.
-Do not allow or facilitate students breaking school policies and rules.
-Do not allow or facilitate students breaking the law.
-Make the safety of the students your highest priority.
If you see or suspect that a student is breaking a school policy or the law, it is your responsibility to inform your group leader immediately.
It is the group leader’s responsibility to provide disciplinary action as needed.
If you believe that a student’s health is in danger, take all appropriate action and inform the group leader.
If you believe that the group leader has not followed school policy, please contact the principal as soon as possible.
Other Policies–Only the principal can provide exemptions to any of the stated policies.
-Students must stay in hotel rooms separate from adults. This includes parents.
-A chaperone must be with the students at all appropriate times. The students cannot be left with other adults/parents who are not on the official chaperone list.
-Students must be grouped with at least 2 other students for all activities.
-Transportation can only be provided through the prior approved list of drivers and vehicles.
Complete the Volunteer Profile Form on the back of this form. The volunteer profile form only has be completed once each school year, unless information changes. Once this information is accepted, you will be placed on a list of approved chaperones and drivers for the remainder of the school year for any field trip for any group. There is two notable exceptions, if you are asked to drive or for overnight field trip. In these cases, you will be given new forms.
Iredell-Statesville Schools
VOLUNTEER PROFILE FORM
The Iredell Statesville Schools has developed a volunteer/chaperone screening process to help ensure the safety of our children. Chaperones forday field trips should complete section I and II of this formand return it to the school principal at least 7 daysbefore the date of the field trip. You may read a copy of School Board Policy 3320 by visiting our website (
Section 1: Volunteer Contact Information Trip Date: ______
Date ______Student Name______School Name ______Grade______
First Name ______Middle/Maiden ______Last Name
Home Address, City, State, Zip______
Home Phone______E-mail Address______
Employer______Business Phone______
Business Address, City, State, Zip______
Have you ever been employed by I-SS? Yes No If yes, give dates of employment: __
Section 2: References
Please print. Complete the following information for three non-family references.
- Name______Relationship ______
Address ______
Street City State Zip
Phone______How long have you known this person? ______
- Name______Relationship ______
Address ______
Street City State Zip
Phone______How long have you known this person? ______
- Name______Relationship ______
Address ______
Street City State Zip
Phone______How long have you known this person? ______
I authorize I-SS to contact the references I have listed.
______
Signature Date