NOVA Volunteer Form

Anyone who might volunteer for NOVA is required to fill this out prior to volunteering. Thank you for helping us keep our students safe and records accurate.

Parent or Guardian of: *

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Primary Phone *

Email Address *

Emergency Contact: *

Primary Phone *

Medical Information

Are there any health conditions we should be aware of (heart disease, diabetes, allergies)? *

Explain

Are there any special medications we should be aware of? *

Explain 🛈

Health Insurance Information *

In case of medical emergency, 9-1-1 will be called unless other directions are given.

Driving Volunteer

Do you plan to drive as a volunteer? *

If you answered yes, please provide your Washington State Driver's License Number so we can obtain a record of your driving record from the Department of Licensing. *

Name as it appears on your driver's license: *

I agree that:

I will comply with all laws and regulations concerning driving, including laws pertaining to the use of seat belts, cell phone use, and speed limits.
I will provide a copy of my Washington State driver’s license.
I understand that NOVA will conduct a Washington State Department of Licensing driving record check and that I have not had more than 3 traffic citations within 36 months.
I am 21 years of age or older.
My vehicle has a valid registration and I will provide a current copy of my vehicle insurance card.
If I drive my own vehicle on behalf of NOVA, I will maintain adequte personal auto insurance. I also understand that as a volunteer driver, my personal auto insurance will be primary for any accidents or incidents that involve my vehicle and NOVA's insurance will be secondary.
I will remain with the whole group on the school trip for the duration of the event, unless other arrangements are explicitly stated by the trip coordinator.
I will ensure that our vehicle leaves with the group, does not make unnecessary stops in between the time of arriving at the destination and returns together with the group to school, unless other arrangements are explicitly stated by the trip coordinator.
I acknowledge that all rules that apply at NOVA for adults and children apply during school trips.
If involved in an accident, I will complete an Accident Report provided by NOVA and to cooperate with police, NOVA's insurer, its insurance adjusters and attorneys, as required.

I have read, understand, and will follow the above driving rules at all times when driving on behalf of NOVA. *

Yes

Required Criminal History and Washington State Patrol Check

All volunteers must be cleared through the Washington State Patrol Criminal History (WATCH) program. By submitting this form, you are granting NOVA permission to conduct the background check. If you do not sign below, we cannot process your request to volunteer and you will be unable to volunteer. WSP results are available upon request.

Required Information for WSP Background Check: *

Male	Female
Prefer not to answer

Birthdate *

List Alias, Maiden Name or other names used, if applicable *

Have you been convicted of a crime relating to abuse, neglect, sexual abuse, exploitation or physical abuse? *

Have you ever been convicted of a crime relating to DUI or drugs? *

Have you ever been convicted of domestic violence or assault? *

Have you ever been convicted of a crime relating to financial exploitation, including extortion, theft, robbery or forgery? *

Have you ever had findings made against you for domestic violence, abuse, sexual abuse, neglect, exploitation or financial exploitation of a child or a vulnerable adult in any civil adjudicative proceeding? *

If you answered YES to any of the above questions, please attach a supplemental sheet with a brief explanation of the convictions and send in a sealed envelope to the attention of Barbara Hutton, Head of School. This information is kept confidential by the Head of School.

I understand I must answer this application truthfully and completely. I certify under penalty of perjury of the laws of the state of Washington that the information I provided above is true and correct. *

Yes