SFASD Annual Volunteer Registration and Disclosure Statement

2019-2020 School Year


Have you submitted the full Volunteer Clearance Packet (Act 34, Act 151 and Act 114) in the past five years?​​​​

Please submit all clearances to Sydney McGill in order for your packet to be complete. Clearances can be submitted via mail, email (volunteerclearances@spring-ford.net), or confidential fax (610-705-6234).

If you have lived in PA for the last 10 years AND are not planning on being a Substantial Volunteering the required clearances are:

Optional:PA Act 114: FBI Fingerprinting report***

*** Volunteer Service Code: 1KG6Y3

(A substantial volunteer may include someone who is in direct contact with students. Direct contact may include, but is not limited to, coaching and/or assisting with an athletic team or musical performing group, advising an extracurricular activity, chaperoning an overnight field trip or competition, and/or providing supplemental assistance to a student without direct supervision by a school district employee.)


If you have not lived in PA for the last 10 years AND/OR are planning to be a Substantial Contact volunteer, the following are required:

*** Volunteer Service Code: 1KG6Y3


Reason for Volunteering​​​​​​​​​
I anticipate volunteering in the following building(s)​​​

VOLUNTEER DISCLOSURE STATEMENTS

The Spring-Ford Area School District Board values the unique contributions made by parents, guardians and community volunteers to the educational and extracurricular programs of the school district. Accordingly, the Board encourages the use of parent/guardian and community volunteers, subject to certain requirements and procedures as set forth below.

Definition of a Volunteer

A volunteer is defined as any individual who performs a service for the school district without compensation, remuneration or other consideration and who otherwise meets the requirements of this policy. A volunteer must be at least eighteen (18) years of age. A volunteer need not be a parent/guardian of a student enrolled in the school district. A volunteer, for purposes of this policy, shall include but is not limited to the following opportunities:

  • Serving as a daily classroom, library or office assistant
  • Assisting with classroom or building special events/celebrations
  • Chaperoning a single day field trip and/or overnight field trip/competition
  • Volunteering with any of the district interscholastic athletic teams and musical performance groups
  • Advising or assisting an extracurricular activity
  • Providing supplemental assistance to a student

Holding the position of a volunteer is not a right, but a privilege conferred upon the volunteer by the Board, acting through the building principal of each school within the school district. All volunteers have specific requirements, including submitting this form, that need to be completed PRIOR to participating in any volunteer experience.

Child Protective Services Law – On December 31, 2014, changes to the Pennsylvania State Child Protective Services Law (CPSL) became effective. Clearance documents for all volunteers are valid with the district for a maximum of five (5) years and must be updated and resubmitted in order to continue as a volunteer. Prior to participating in any volunteer opportunity, each volunteer shall be required to complete and submit:

  • Act 34 (Criminal History Clearance Report)
  • Act 151 (Child Abuse Clearance Report)
  • Act 114 (FBI Criminal Clearance Report)

The new volunteer clearance requirements went into effect July 1, 2015.

I. I affirm under the penalty of perjury that I have not committed, pled guilty to and/or been convicted of, nor am I presently charged with, any of the following offenses:

(1) An offense under one or more of the following provisions of Title 18 of the Pennsylvania Consolidated Statutes:

  • Chapter 25 (relating to criminal homicide)
  • Section 2709.1 (relating to stalking)
  • Section 2902 (relating to unlawful restraint)
  • Section 3121 (relating to rape)
  • Section 3123 (relating to involuntarily deviate sexual intercourse)
  • Section 3124.2 (relating to institutional sexual assault)
  • Section 3126 (relating to indecent assault)
  • Section 3129 (relating to sexual intercourse with an animal)
  • Section 4303 (relating to concealing death of child
  • Section 4305 (relating to dealing in infant children)
  • Section 5903(c) or (d) (relating to obscene and other sexual materials and performances)
  • Section 6312 (relating to sexual abuse of children)
  • Section 6319 (relating to solicitation of minors to traffic drugs)
  • Section 2702 (relating to aggravated assault)
  • Section 2901 (relating to kidnapping)
  • Section 2910 (relating to luring a child into a motor vehicle or structure)
  • Section 3122.1 (relating to statutory sexual assault)
  • Section 3124.1 (relating to sexual assault)
  • Section 3125 (relating to aggravated indecent assault)
  • Section 3127 (relating to indecent exposure)
  • Section 4302 (relating to incest)
  • Section 4304 (relating to endangering welfare of child)
  • A felony offense under Section 5902(b) (relating to prostitution)
  • Section 6301(a)(1) (relating to corruption of minors)
  • Section 6318 (relating to unlawful contact with minor)
  • Section 6320 (relating to sexual exploitation of children)

(2) An offense designated as a felony under the act of April 14, 1972 (P.L. 233, No. 64) known as “The Controlled Substance, Drug, Device and Cosmetic Act.”

(3) An offense SIMILAR IN NATURE to those crimes listed in clauses (1) and (2) under the laws or former laws of the United States or one of its territories or possessions, another state, the District of Columbia, the Commonwealth of Puerto Rico or a foreign nation, or under a former law of this Commonwealth.

II. I affirm that I have not committed, pled guilty to and/or been convicted of, nor served a sentence for, any offense graded as a felony offense of the first, second or third degree, within the past ten (10) years.

III. I affirm that I have not committed, have not pled guilty to and/or been convicted of, nor served a sentence for, any offense graded as a misdemeanor of the first degree, within the past five (5) years.

IV. I affirm that I have not on more than one occasion pled guilty to and/or been convicted of any offense under 75 Pa.C.S. Section 3802(a), (b), (c) and/or (d) (relating to driving under the influence of alcohol or controlled substance) that was graded as a misdemeanor of the first degree, or, if I have so pled guilty and/or been convicted of such offense(s) on more than one occasion, that I have not pled guilty to and/or been convicted of, nor served a sentence for any of those convictions within the past three (3) years.

V. I affirm that I have not been named as a perpetrator of a founded report of bodily injury, sexual abuse, or sexual exploitation of a child.


Azerbaijan, Belarus, Democratic People’s Republic of Korea, Djibouti, Gabon, Georgia, Kazakhstan, Kiribati, Kyrgyzstan, Lesotho, Mongolia, Mozambique, Myanmar, Namibia, Papua New Guinea, Republic of Moldova, Russian Federation, Somalia, South Africa, Swaziland, Tajikistan, Ukraine, Uzbekistan? ​​​​​​
Azerbaijan, Belarus, Democratic People’s Republic of Korea, Djibouti, Gabon, Georgia, Kazakhstan, Kiribati, Kyrgyzstan, Lesotho, Mongolia, Mozambique, Myanmar, Namibia, Papua New Guinea, Republic of Moldova, Russian Federation, Somalia, South Africa, Swaziland, Tajikistan, Ukraine, Uzbekistan? ​​​​​​​​

Since the country was listed as having an incident rate of greater than or equal to 20 per 100,000 cases as per the World Health Organization (WHO), you are required to answer the following*. Have you experienced:

*If yes to any of the below questions, the volunteer must have an Interferon - Gamma Release Assay (IGRA) blood test or a PPD skin test completed by a physician. A report must be on file with the district PRIOR to volunteering in the district.*

Since the country was listed as having an incident rate of greater than or equal to 20 per 100,000 cases as per the World Health Organization (WHO), you are required to answer the following*. Have you experienced:

*If yes to any of the below questions, the volunteer must have an Interferon - Gamma Release Assay (IGRA) blood test or a PPD skin test completed by a physician. A report must be on file with the district PRIOR to volunteering in the district.*



By submitting this form, I certify that I have provided true and correct information on this form to the best of my knowledge, information and belief. I understand that my verification of the accuracy of this information on this form is made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities.


Please provide an email address where we can send a link to your current form.

Email Address :