LAST name:     FIRST name:   E-mail Address:     Phone #:

Mon, Tues, Thurs, Fri		Wed
Before School	7:20 -  7:37	Before School	9:32 – 9:52
Gray Lunch	10:19 - 10:49	6th Grade lunch	11:10 - 11:40
Maroon Lunch	10:49 - 11:19	Gray Lunch	11:49 - 12:19
6th Grade Lunch	11:19 - 11:49	Maroon Lunch	12:28 - 12:58
After School	2:01 – 2:15 pm	After School	2:16 –  2:30

Please indicate the day and shift you prefer to volunteer below.  If you are available for a lunch shift and can cover two or three lunch periods, please let us know (example:  First Choice:   Day: Monday    Shift: combined gray, maroon)

First Choice:          Day:       Select one: Monday Tuesday Wednesday Thursday Friday    Shift:   Select one: Before school Gray Lunch Maroon Lunch 6th Lunch Combined Gray, Maroon Combined Maroon, 6th Combined Gray, Maroon, 6th Combined Wed - 6th, Gray Combined Wed - Gray, Maroon Combined Wed - 6th, Gray, Maroon After School

Second Choice:     Day:       Select one: Monday Tuesday Wednesday Thursday Friday None     Shift:   Select one: Before school Gray Lunch Maroon Lunch 6th Lunch Combined Gray, Maroon Combined Maroon, 6th Combined Gray, Maroon, 6th Combined Wed - 6th, Gray Combined Wed - Gray, Maroon Combined Wed - 6th, Gray, Maroon After School None

Third Choice:        Day:       Select one: Monday Tuesday Wednesday Thursday Friday None     Shift:   Select one: Before school Gray Lunch Maroon Lunch 6th Lunch Combined Gray, Maroon Combined Maroon, 6th Combined Gray, Maroon, 6th Combined Wed - 6th, Gray Combined Wed - Gray, Maroon Combined Wed - 6th, Gray, Maroon After School None

How often would you like to volunteer?         Select one: Once a week Twice a week Every other week Once a month Substitute only   

Would you like to be contacted when we need a sub?    Yes No

Additional Comments:

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Walkabout Participant Statement of Understanding

I   (first and last name) will be involved in the Walkabout Program and understand what the program is about and my role as a parent volunteer.  I agree to the following statements:

1. I understand that this is a support program versus an enforcement program and will act accordingly as a supporter of the community to keep it safe and healthy.

2. I will ender situations only if I feel comfortable and have been informed of the options to get support when needed.

3. I have read or been given a copy of the school rules and accept them as they are.

4. I understand that confidential information may be conveyed to me directly or indirectly as a participant of this program and I will agree to the rules of confidentiality as defined by the coordinators or school administrator.

5. I will interact with students as needed and act as a positive role model while I participate in the program.

6. I understand that I can be removed from the program at anytime due to inappropriate conduct as determined by the coordinators or the school administration.

I have read the statements above and agree to them as written.  I also understand that these statements are only a part of the training involved and that some details are not included in the statement.

I agree to the above terms Yes   No                        Date:  09/09/2008

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