Coach Volunteer Form
Warrior Athletic Club (WAC)
Last Name:
_____________________ First Name:
_____________ Middle Initial:___ Maiden Name (if applicable):__________
Complete Address:
Email Address:
___________________________________
Home Phone: ________________
Work Phone: _______________
Occupation:
________________________________________
Employer:
______________________________________________
Employer Address: _________________________________
Date of Birth (mm/dd/yy):
_____/_____/_____ Social
Security Number: _____-_____-_______
Please check where you would be willing to help:
_____Team Coach _____Assistant Coach T-Shirt Size (Adult) ___S ___M
___L ___XL ___XXL
Do you have children in the WAC
program? _______ Name(s)________________________________________________
If yes, at what level?
______________
List your qualifications and
experiences:
___________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Have you ever been convicted of,
or plead guilty to, any crime(s):
___Yes ___No
If yes, describe each in
full:
______________________________________________________________________________
____________________________________________________________________________________________________
Have you ever been refused
participation in any other youth program?
___Yes ___No
If yes, explain:
_________________________________________________________________________________________
______________________________________________________________________________________________________
As a condition of
volunteering, I give permission for the Warrior Athletic Club (WAC)
organization to conduct a background check on me, which may include a review of
sex offender registries, child abuse and criminal history records. I understand that, if appointed, my position
is conditional upon the WAC receiving no inappropriate information on my
background. I hereby release and agree
to hold harmless from liability the Warrior Athletic Club (WAC), the officers,
employees and volunteers thereof, or any other person or organization that may
provide such information. I also
understand that, regardless of previous appointments, the WAC is not obligated
to appoint me to a volunteer position.
Applicant Signature: ____________________________________________________ Date: _______________________________