Volunteer Application *First Name *Middle Name *Last Name Address City State Zip Cell Phone Work Phone Home Phone Email Address Date of Birth Occupation Employer Special professional training, skills, hobbies Community affiliations (clubs, service organizations, etc.) Previous Volunteer experience (including soccer and year(s)) Do you have children in the program? YesNo If yes, list full name and division Special Certification? (CPR, Medical, etc.) YesNo Do you have a valid driver’s license? YesNo Driver’s License # State Have you ever been convicted or plead no contest/guilty to any crime(s) involving a minor? YesNo If yes, describe in full Do you have any criminal charges pending against you regarding any crime(s)? YesNo If yes, describe in full Have you ever been refused participation in any other youth programs? YesNo If yes, explain In which of the following would you like to participate? (Check one or more) Executive Board MemberBoard MemberCommittee Assistant Interested Position(s) Please list two references: Name Phone Number Relationship Name Phone Number Relationship Please provide a copy of a valid government ID AS A CONDITION OF VOLUNTEERING, I give permission for the South Range Soccer Club to conduct a background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if elected, my position is conditional upon the club receiving no inappropriate information on my background check. I hereby release and agree to hold harmless from liability the South Range Soccer Club, the board members, coaches, and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, South Range Soccer Club is not obligated to elect me to a volunteer position. If elected, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board Members for violation of South Range Soccer Club policies or principles. Applicant Name (please print) Applicant Signature
