Youth Coach Application
Background Screening Application
Wakefield Youth Rec requires that youth coaches whose position requires routine access to children must be screened. Your signature on this application signifies that you agree to allow Wakefield Youth Rec or an assigned agency to perform a criminal background screening. This will include a review of sex offender registries, child abuse, and criminal history records. I hereby release and hold harmless from liability Wakefield Youth Rec, the officers, employees, agents, volunteers thereof, and any other person or organization that may provide such information in accordance with the laws of the United States. I further understand that previous acceptance as a Wakefield Youth Rec Coach does not obligate Wakefield Youth Rec or its local Association, to accept my current application.
1. I have not been convicted (including crimes that have been expunged or pleas of “no contest”), disciplined, or discharged from employment for committing or attempting to commit crimes in the area of:
a. Child abuse
b. Sexual abuse of a minor
c. Physical abuse
d. Murder or manslaughter
e. Felony assault
f. Kidnapping
g. Arson
h. Criminal sexual conduct
i. Neglect of a child
j. Abuse causing a child’s death
k. Prostitution related crimes
l. Child pornography
m. Child exploitation
n. Controlled substance crimes
o. Juvenile prostituting or pimping.
2. I have not been convicted of any offense in any other state or against the laws of the United States which if committed or attempted in this state would have been punishable as one or more of the foregoing enumerated offenses.
3. I have not been found liable for civil penalties or damages involving sexual or physical abuse of children.
4. I have not been subjected to any court order involving any sexual or physical abuse of a minor.
5. I have not had my parental rights terminated at any time.
6. I understand that I have an ongoing obligation as a volunteer/employee of this organization to promptly report any conviction in the areas described above. (If you have committed or attempted to commit any of these crimes, please explain the circumstance to the situation on a separate sheet of paper.)
7. If selected as Head Coach, I understand that I am responsible for any taxes owed on payments received from Community Recreation of Wakefield.