VOLUNTEER IN YOUTH SPORTS

Lake Fenton Application Form

Date ________________

Position: Cheer or Football (circle one) Title____________________________

(Head Coach, Assistant, Board Position)

Full Legal Name of Applicant _______________________________________________

Other Names (Maiden, Alias etc) ____________________________________________

Address ________________________________________________________________

City __________________________________ State ____________ Zip ____________

Daytime Phone (____)__________________ Evening Phone (____)________________

Email Address ______________________________ Date of Birth__________________

Social Security Number _____________________________ Male _____ Female _____

Drivers License Number _______________ State ________ Expiration Date _________

Previous Address (List Address if not at current address for 5 years):

Street _______________________________________________________ Apt # ______

City _________________________________ State __________ Zip _______________

Present Employer _____________________________________ Hire Date ___________

Employers Address _______________________________________________________

City _________________________________ State __________ Zip _______________

Position ________________________________________________________________

Name of Supervisor _______________________________________________________

References (List 3 not family relations)

Name_______________________ Address______________________ Phone________

Have you ever been arrested, charged or convicted of a crime? No ______ Yes ______

If yes, please explain:

________________________________________________________________________

Have you ever had or do you currently have a problem with drugs and/or alcohol?

No ______________ Yes _____________

If yes, please explain:

________________________________________________________________________

What is your motivation to volunteer for this position?

________________________________________________________________________

List any formal training that you have completed that is related to this position:

________________________________________________________________________

Do you have Automobile Insurance? Yes __________ No ________

Name of Company________________________________________________________

I understand and agree that:

1. This organization can deny any applicant for any reason or for no reason at

all.

2. This application is valid for 1 (one) year and a new application has to be

completed immediately thereafter.

3. By submitting this application I, the applicant, affirm that all the foregoing

information I have provided is true and correct.

4. By submitting this application I, the applicant, agree (in return for being

permitted to volunteer) that if any of the foregoing information is incorrect, I

will forever indemnify and hold this organization harmless for any acts or

omissions on my behalf as they relate to any incorrect information I have

provided.

5. By submitting this application I, the applicant, voluntarily waive my privacy

rights to the extent necessary for the youth organization to verify the

foregoing information through any reasonable means, including, but not

limited to local, state, national and international criminal background check(s)

and to inform those within the organization who are responsible for accepting

and/or supervising volunteers.

Print Name ______________________________________________________________

Signature __________________________________________ Date_________________

Please submit completed form to Ken Hill for Football or Lori Zielinski