SOUTHINGTON KNIGHTS TRAVEL FOOTBALL & CHEERLEADING

VOLUNTEER APPLICATION

ASSOCIATION: / Southington Knights Travel Football & Cheerleading / SEASON: / 2017

Volunteer Interest: Note: All shaded positions require background check.

ADMIN
POSITIONS / PRESIDENT / VICE PRESIDENT / TREASURER / SECRETARY / BOARD MEMBER
CHEER COORD. / HEADCOACH / ASST. COACH / TRAINER / DEMONSTRATOR
FUNDRAISING / PAPERWORK / OTHER (Please Specify)

All ADULT LEAGUE PERSONEL with repetitive access to minor participants requires a background check per league policy.

COACHING
STAFF
POSITIONS / FOOTBALL / FLAG / CHEER
8th Grade / 7th Grade / 6th Grade / Fundamental Flag / Fundamental Cheer
5th Grade / 4th Grade / 79ers / Competition Cheer

Personal Info: Note: All shade areas required information.

NAME: / DATE:
ADDRESS: / CITY: / STATE: /

CT

/ ZIP:
SOC. SECURITY #:
DATE OF BIRTH: / DRIVERS LIC. # / EXP. DATE
HOME PHONE / WORK PHONE / CELL PHONE / FAX / EMAIL ADDRESS
EMPLOYER: / OCCUPATION:
ADDRESS: / CITY: / ST: / / ZIP:

COACHING BACKGROUND (LIST EXPERIENCE / DESCRIBE YOUR PHILOSIPHY):

COMMUNITY AFFILIATIONS (CLUBS, SERVICE ORGANIZATIONS, ETC.):

PREVIOUS VOLUNTEER EXPERIENCE (INCLUDING OTHER YOUTH SPORTS):

ORGANIZATION / POSITION / YEAR
HAVE YOU EVER HAD NYSCA CERTIFICATIONS FOR FOOTBALL / CHEERLEADING / OTHER? / YES / NO
IF OTHER PLEASE EXPLAIN.
DO YOU HAVE ANY SPECIAL CERTIFICATIONS i.e. CPR, AHTLETIC TRAINER, MEDICAL ETC. IF SO, PLEASE LIST. / YES / NO
1.
2.
3.
4.

REVISED 3/10/17 PAGE 1

SOUTHINGTON KNIGHTS TRAVEL FOOTBALL & CHEERLEADING

VOLUNTEER APPLICATION

ASSOCIATION: / Southington Knights Travel Football & Cheerleading / SEASON: / 2017
NAME: / PAGE 2

REFERENCES: (PLEASE DO NOT LIST FAMILY MEMBERS)

NAME / PHONE

ADDITIONAL INFORMATION:

DO YOU USE ILLEGAL DRUGS? / YES / NO
HAVE YOU BEEN CONVICTED OF A CRIMINAL OFFENSE? / YES / NO
HAS YOUR DRIVER’S LICENSE EVER BEEN SUSPENDED OR REVOKED? / YES / NO
IS THERE ANY FACT OR CIRCUMSTANCE INVOLVING YOU OR YOUR BACKGROUND THAT WOULD CALL INTO QUESTION YOUR’E BEING ENTRUSTED WITH THE GUIDANCE, SUPERVISION, CARE OF YOUNG PEOPLE? (IF YES EXPLAIN BELOW). / YES / NO

I UNDERSTAND THAT:

1.  AS A CONDITION OF VOLUNTEERING, I GIVE PERMISSION TO SOUTHINGTON KNIGHTS TRAVEL FOOTBALL & CHEERLEADING AND ITS AFFILIATES TO CONDUCT A BACKGROUND CHECK ON ME, WHICH MAY INCLUDE CONTACTING PERSONS AND ORGANIZATIONS HEREIN PROVIDED AND/OR A REVIEW OF DMV, CRIMINAL AND CHILD ABUSE RECORDS MAINTAINED BY GOVERMENTAL AGENCIES. I UNDERSTAND THAT, IF APPOINTED, MY POSITION IS CONDITIONAL UPON THE LEAGUE RECEIVING NO INAPPROPRIATE INFORMATION ON MY BACKGROUND. I HEREBY RELEASE AND AGREES TO HOLD HARMLESS FROM LIABILITY THE LEAGUE, IT’S AFFILIATES, OFFICERS AND VOLUNTEERS THEREOF, OR ANY OTHER PERSON OR ORGANIZATION THAT MAY PROVIDE SUCH INFORMATION.

2.  I UNDERSTAND THAT, REGARDLESS OF PREVIOUS APPOINTMENTS, SOUTHINGTON KNIGHTS TRAVEL FOOTBALL & CHEERLEADING AND ITS AFFILIATES IS NOT OBLIGATED TO APPOINT ME TO A VOLUNTEER POSITION. IF APPOINTED, I UNDERSTAND THAT, PRIOR TO THE EXPIRATION OF MY TERM, I AM BOUND BY THE BYLAWS AND RULES OF LEAGUE’S AND ITS CURRENT AFFILIATION AND ITS AFFILIATES AND SUBJECT TO SUSPENSION BY THE SUPERVISING ASSOCIATION PRESIDENT AND REMOVAL BY THE BOARD OF DIRECTORS FOR VIOLATIONS OF ITS PUBLISHED GOVERNING BYLAWS, RULES, REGULATIONS, POLICIES AND PROCEDURES AND/OR ANY BEHAVIOR DEEMED DETRIMENTAL TO THE PARTICIPATING PROGRAM.

SIGNATURE OF APPLICATE: / DATE:

Note: Southington Knights Travel Football & Cheerleading and its affiliates will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability.

FOR LEAGUE / ASSOCIATION USE ONLY:

SYSTEM(S) USED FOR BACKGROUND CHECKS. MINIMUM OF ONE MUST BE CHECKS.
Online multi state database / State/Local criminal records / Sex offender registry / Other:
APPLICATION REVEW DATE:
APPLICATION STATUS: / APPROVED – (1A) / DELAYED – (1D) / DENIED – (2D)
REASONS DENIED:
NAME OF OFFICER - Performing check: / DATE:

REVISED 3/10/17 PAGE 1