Appendix D.II.
Catastrophic Sick Leave Bank
Enrollment Form

Name ____________________________________              Site __________________________

Assignment _____________________________________________________________________

Employee hereby acknowledges that the donation of one sick leave day is voluntary. Employee agrees to indemnify and hold the Committee, District and Association harmless from any claims, demands, or causes of action related to the donation or to the granting or denial of any leave pursuant to this article.

Signature of Employee ___________________________________  Date ___________________

(To be completed by Catastrophic Sick Leave Committee)

Attention: Personnel Office

One day of sick leave has been approved by the Committee to be deducted from the accumulated sick leave of the above certificated employee and placed in the Catastrophic Sick Leave Bank.

Signature of Committee Member ___________________________________________________

Date _________________________________