Limited Criminal History and Sex Offender Registry Form

Please print and return to your child's teacher or the school office at least five days prior to your first visit or date to volunteer. 

First Name________________ Middle Initial_____ Last Name_________________________

Date of Birth_______________ Race____________________ Gender__________________

Name of student(s) and their room number(s)______________________________________

__________________________________________________________________________

Relationship to student(s)______________________________________________________

Phone Number__________________(in case we need to contact you about your information)

I have read and accept the terms for volunteering and or visiting Paragon Elementary.

Signature______________________________________________ Date_________________

____________I have no plans to volunteer at this time but will submit the information required

                                                                                                          later if my plans change during the year.

Thanks again for your support!  Should you have any questions regarding this, please do not hesitate to call the school at (765) 537-2276.

Your cooperation in keeping our school environment safer is greatly appreciated.