Kensington Recreation Committee

VOLUNTEER FORM

NAME: ___________________________________________________________________________

STREET: _______________________________ TOWN: _____________________ STATE: ________ 

MAILING ADDRESS (IF DIFFERENT) __________________________________________________

DATE OF BIRTH __________ SEX: MALE / FEMALE (CIRCLE ONE)      

DAYTIME PHONE: ______________EVENING PHONE: ________________

CELL PHONE: __________________EMAIL:___________________________

ACTIVITY OR PROGRAM YOU ARE VOLUNTEERING FOR: ___________________________________________________________________________________________

DO YOU HAVE ANY SPECIFIC REQUESTS? ___________________________________________________________________________________________

PREVIOUS COACHING EXPERIENCE (List Sport and age group):  ___________________________________________________________________________________________

HAVE YOU EVER BEEN ARRESTED OR CONVICTED OF A CRIME THAT WOULD MAKE YOU UNSUITABLE FOR WORKING IN CLOSE PROXIMITY TO CHILDREN?  ____________

IF YES, PLEASE EXPLAIN:

__________________________________________________________________________________________

___________________________________________________________________________________________

TO INSURE THE SAFETY OF OUR CHILDREN ALL VOLUNTEERS WILL BE SUBJECT TO A CRIMINAL BACKGROUND CHECK. YOUR SIGNATURE ON THIS FORM INDICATES YOUR ACCEPTANCE OF THIS REQUIREMENT. BACKGROUND CHECKS WILL BE CONDUCTED CONFIDENTIALLY AND AT NO COST TO YOU. YOU WILL ONLY BE CONTACTED AS A RESULT OF THIS CHECK IF THERE IS A PROBLEM.

SIGNATURE OF APPLICANT: _______________________________________ DATE: ______________

STAFF SIGNATURE: __________________________________ DATE OF RECEIPT: _____________

Thank you, without you these programs would not happen!

Kensington Recreation Committee