Parent and Guardian Consent Form

I authorize SSV to share written information regarding participation and performance in the assigned volunteer program. Further, I authorize Springfield Public Schools (SPS) to disclose to SSV information in my student’s record, including but not limited to enrollment, attendance, behavior, and academic performance data. I understand that the purpose of sharing this information is to enable SSV and SPS to improve the quality and alignment of services and education for students. I also understand that the shared information will be stored in a secure, password-protected electronic database maintained by the Springfield Public Schools and only accessible to those with authorized access.
I understand that SSV generally discloses only non-identifiable, student data and that SSV may disclose specific data only to the volunteer with whom the student is working. In the event that my young person is no longer enrolled in the Springfield Public Schools or ceases participation in SSV’s programs or services, both organizations will terminate all information sharing within a reasonable period of time. Both organizations will also terminate any information sharing if I revoke this authorization in writing, delivered to the Springfield Public Schools and SSV.