Pooler Recreation Department
Volunteer Application Form
A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE ATTACHED TO COMPLETE THIS APPLICATION.
Turn in a completed volunteer application form, Have a background check completed, Receive confirmation from PRD staff and
Turning in a volunteer application does not guarantee acceptance as a PRD volunteer
Name:
Address: ___________________________ City__________ State______ Zip Code_____
E-mail Address:
Phone No: __________________Cell No:
Date of Birth_____________ Social Security # (mandatory)_____________
Occupation_____________ Employer______________ Address__________________________
Do you have a valid Driver’s License? Yes
No
Driver’s License #:__________________ State: _______________________
1. What experience do you have as a coach?
______
2. Please describe any other youth activities that you have been involved in and how that experience will help you be an
effective coach.
3. Have you ever attended any coaching, umpire or player clinics?
4. Do you have a child participating in the league? Please list player(s) name(s) and division(s).
5. Have you ever been convicted or plead guilty to any crime(s): Yes
No
If yes, describe each in full:____________________________________________________________________________
6. Are there any criminal charges pending against you regarding any crime(s) involving or against a minor? Yes No
If yes, describe each in full:____________________________________________________________________________
7. Have you ever been refused participation in any other youth programs? Yes
No
If yes, explain:_______________________________________________________________________________
Please list three references, at least of which has knowledge of your participation as a volunteer in a youth program.
Name/Phone
1.
2.
3.
As a condition of volunteering, I give permission for Pooler Recreation to conduct 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, child abuse, and criminal history record. I understand that, if appointed, my position is conditional
upon the league receiving no inappropriate information on my background. I understand that the information I have provided may be verified by contacting persons
or organizations that may have information pertaining to me. I hereby release and agree to hold harmless any person or organization that may provide information. I
pledge to carry out all rules, regulations, and policies of the league and abide by any ruling made by the Pooler Recreation regarding any situation which may arise
during the season. In signing this application, I affirm that the information I have given is true and correct.
Name:_____________________ Signature of Applicant:
Date:
Pooler Police Department Use Only:
Background check completed by: _____________ System(s) used for background check: _________________
Only attach to this application copy of background check reports that reveal convictions of this application.