Diocese Volunteer Form – St. Mary's Catholic School

This form is to be completed and submitted in conjunction with completion of Safe Environment training and Background Check. All materials will remain at St. Mary's Catholic School.

CONFIDENTIAL

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Length of residency in Wyoming in Years *

Home Phone

Cell Phone

Work Phone

Has any allegation or complaint ever een made against you relating to physical abuse, sexual abuse, harassment or exploitation? *

Yes
No

Have you ever been convicted of a crime of physical abuse, sexual abuse, harassment or exploitation? *

Yes
No

Have you ever been convicted of a felony? *

Yes
No

List activities you spent time volunteering with:

IN THE COURSE OF MY DUTIES I WILL:

Have access to children (under 18). *

Yes
No

Drive a vehicle on school business. *

Yes
No

Have unsupervised access to school cash over $100. *

Yes
No