Peer
Court Volunteer Application: Parent
Permission
By signing below, I give my child
permission to participate in Peer
Court activities, including but not limited to the
following:
- Training
at CCDS -- Participate
in Peer Court training sessions and other activities at CCDS offices at: 149
Natoma Street, San Francisco, CA 94105. Phone 415-865-2524
- Peer
Court Service -- Serve
on a school or neighborhood Peer
Court.
- Field
Trips -- Attend
out of school activities including Field Trips with Peer Court staff. Your permission
will be requested in writing for each Field Trip.
- Media Release/Permission To Use Image, Voice or Likeness -- Peer
Court advertises its program through videos and
other promotional materials that are distributed to youth and adults who
may be interested in the program as volunteers, participants, funders or
other stakeholders. By signing below, I give my permission for Peer Court to
use and distribute my own or my child’s image, voice or likeness in
promotional materials developed by or about the program including
newsletters, photographs, film, video, printed materials, audio recordings
or other forms.
- Travel
to Other Schools -- I
grant permission for my child to provide Peer Court services to students at
other schools as arranged and attended by Peer Court staff.
- Travel
with Peer Court
Staff -- I grant
permission for my child, when necessary, to travel with Peer Court staff members in their
private automobiles to and from Peer
Court functions such as hearings, field
trips, training sessions, etc.
- Contact
by Peer Court
Staff -- I
understand that to operate Peer
Court properly it may be necessary for Peer
Court Staff to contact, or be contacted by, my child via telephone, email,
or in person at the school site.
- Background
Check -- I give
my consent to have a background check performed by the Juvenile Probation
Department, LiveScan or other agency to check for current probation status
and any history of offenses against minors.
I certify that I am
the Parent/Guardian of _______________________________________ and I
acknowledge and give my consent to the above outlined eight (8) items.
Name of
Parent/Guardian: _______________________________
Phone______________
Address _________________________________
City ______________ Zip ___________
Signature of Parent/Guardian
_______________________________ Date _____________