BetaCon23 State Chaperone Registration

BetaCon23 Chaperone Registration Form

This form allows for parents, guardians, and alumni the opportunity to apply to be a chaperone for the 2023 convention season. Application DOES NOT mean that you will be selected as a chaperone. Selection will be based on club needs, seniority, and prior service. Chaperones travel with the club. Please do not ask to chaperone if you cannot travel at the same times as the student members. All costs, dates, and times are approximate. At this time State chaperone cost is $75 ($100 if you ride the bus). Nationals chaperone cost is approximately $400.

Conventions (mark all that apply)

State Convention (November 28-30, Nashville, TN)

National Convention (June 16-21, Louisville, KY)

Name*

First

Last

Middle

Date of Birth*

day

month

year

Personal Cell Phone (555) 555-5555*

T shirt Size (all sizes Adult)*

Name of related Beta (type none if needed)*

Relationship to Beta *

EMAIL*

1st choice Beta to be assigned

2nd choice Beta to be assigned

3rd choice Beta to be assigned

4th choice Beta to be assigned

I understand that this form does not guarantee a place as a chaperone.

I understand that, as a chaperone, I am not compensated for any services, including wages and insurance. I further understand that I have the right to terminate my arrangement at any time with or without cause, and the LHS Beta Club has a similar right. I make this agreement in order to provide and to be authorized to perform uncompensated services to the LHS Beta Club:

I am 18 years of age or older and know of no reason which would prevent me from performing my duties as a chaperone.
I have acquainted myself with what is required to perform my assigned tasks, and I represent that I have the skill and ability to perform them.
I assume full responsibility for my own safety and the safety of others.
That I will perform the chaperone/volunteer service in compliance with the standards and specifications established, or approved, by the District, and will honor the direction of LHS Beta Sponsors/School officials, to suspend or terminate service.
As a volunteer, I agree to abide by the following code of conduct:
- I will maintain confidentiality outside of school and will share any concerns that I may have with sponsors.
- I agree not to transport students other than my own legal child. I will not disclose, use or disseminate student photographs or personal information.
- I agree not to post, transmit, publish or display harmful or inappropriate matter that is threatening, obscene, disruptive or sexually explicit or that could be construed as any form of harassment.
- I agree only to do what is in the best personal and educational interest of every child with whom I come into contact.
- I agree to conduct myself in the same manner as educators during my duties as a chaperone which includes not partaking in tobacco, alcohol, drugs, profane language, etc. while responsible for students.
- I agree to leave discipline to the sponsors. I will verbally guide students and immediately report any failure to follow my directions or violation of any behavior standard.

Acknowledgement of Chaperone Requirements*

verification

Success!