Student Volunteer Permission Form

This form is to be completed by the parent or legal guardian of the student volunteer

LifeWise Academy is a non-denominational, Bible-based released time religious instruction program with emphasis on character education.

Student volunteers act in a variety of capacities, including: assisting teachers as needed with class activities and traveling with students to and from the school building. All student volunteers will be supervised by an adult.

For more information about LifeWise Academy, go to lifewise.org.

Parent/Guardian Information

First Name

Last Name

Email Address

Phone Number

Street Address

City

State/Providence

Postal/Zip Code

Church Information

Home Church

Church Reference Name #1 (Pastor or mentor who knows the student personally)

Church Reference #1 Phone Number

Church Reference Name #2 (Pastor or mentor who knows the student personally)

Church Reference #2 Phone Number

Student Information

LifeWise Program for which student is interested in volunteering

Student First Name

Student Last Name

Birthdate

Student Age

Student Email

Student Phone Number

T-Shirt Size

Parental Questionnaire and Consent

Has your student been arrested or convicted of a crime?

Are you aware of any traits or tendencies that your student possesses that could pose a threat to children, youth or others?

Has your student ever been reprimanded or disciplined for any behavior of a violent or sexual nature?

If you answered "yes" to any of the questions above, please explain:

I affirm that I am the parent/legal guardian of the applicant.I affirm and attest that the information provided is true and correct.I consent to my student volunteering in the LifeWise Academy released time religious instruction program.

Custodial Parent/Guardian Name

Custodial Parent/Guardian Signature

By selecting "I Agree", I accept that my electronic signature is the legal equivalent of my manual / written signature for this document.

I Agree

Program ID

Contact Information