Tutor/Volunteer Registration Form

Page 1

LC Logo

























To select more than one value for questions, hold down Ctrl key while selecting.







Tutor Orientation and Training are available online and in person.  You will receive an email with details.



LITERACY CONNECTIONS VOLUNTEER AGREEMENT

 

I understand that by volunteering with Literacy Connections, I am becoming part of a program that will support me, answer my questions and provide assistance with my tutoring experience.

 

I understand that my responsibility to the team is to ask questions, maintain open communication, meet with my students at the scheduled time (except in case of sickness or emergency when I will call my student before he or she leaves to meet me).  I agree to meet for at least six months for two hours per week.  I will also attend in-service training each year, maintain accurate records and forward them to the office at the scheduled times.  I will follow all other policies and procedures of Literacy Connections.

 

I allow Literacy Connections to use my picture in publicity materials.  I will follow Literacy Connections’ safety policies which include: no infliction for physical, verbal or emotional harm on others; no possessions of weapons; no possession or use of drugs or alcohol during Literacy Connections activities.


By clicking Accept. this shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

Page 2

LITERACY CONNECTIONS VOLUNTEER CONFIDENTIALITY STATEMENT

 

I promise to hold in confidence all information regarding students of Literacy Connections.  This means I will protect the privacy of students in the Literacy Connections program by not revealing any identifying information.

 

 I accept full responsibility for maintaining the confidential and private nature of all records, information and student writing.  I fully understand that I can discuss cases assigned to me only with designated Literacy Connections staff.

 

 I understand that I am personally responsible and fully liable for any violation of this agreement.

 

By clicking Accept. this shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

Page 3

LITERACY CONNECTIONS VOLUNTEER AGREEMENT: WAIVER OF LIABILITY

 

I, the undersigned, being a volunteer tutor in the literacy program sponsored by Literacy Connections of Wayne County (Wayne County), acknowledge that I have been advised that Literacy Connections does not require references from or otherwise screen persons desiring to be tutored, and I further acknowledge that Literacy Connections, and its staff, officers, directors, advisors and affiliates bear no responsibility or obligation to me for any claim which I might have arising out of any injury or damage to me or my property caused wholly or partially by any person whom I agree to tutor or by any other person in connection with my partnership in the literacy program.  Further, I release Literacy Connections, its staff, officers, directors, advisors and affiliates, from any liability or responsibility whatsoever for any such injury or damage.

I acknowledge that I am participating in the literacy program voluntarily, and I hereby assume all risks arising in connection with participation.  Without limiting the foregoing, I specifically assume the risk of traveling to and from any location where that tutoring is conducted and being on the premises where the tutoring is conducted and I release the Literacy Connections staff, its officers, directors, advisors and affiliates, from any liability or responsibility arising with respect thereto.  I further acknowledge that I understand the provisions hereof.

By clicking Accept. this shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.