Using Athletics to Cope Mentor/Volunteer Application Form

Using Athletics to Cope Mentor/Volunteer Application Form
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Do you need accommodation services in order to perform your duties?*

YesNo
If yes, what type of accommodation services do you need?
Emergency Contacts*
Education Level*
School Name*
Birthdate*

MonthDayYear
Date
How did you find this volunteering program?*
Availability Sunday
Availability Monday*
Availability Tuesday*
Availability Wednesday*
Availability Thursday*
Availability Friday*
Availability Saturday
Why do you want to be a volunteer in this program?*
Please tell us your other volunteering experiences.*
What are your interests?*
What are your skills?*
ie. Graphic Design, Social Media
Photographic & Volunteer Release

I hereby acknowledge that the information given above is accurate and I give permission to the community for the use of my photographs that are taken by staff in order to use for social media.
Background Check & Fingerprinting Consent

I hereby acknowledge that the information given above is accurate and I give permission to the community for the use of my photographs that are taken by staff in order to use for social media.
Mandatory Reporting Acknowledgement

I understand that if I observe or suspect abuse, neglect, exploitation, or threats of harm involving a child or youth, I must immediately notify UAC leadership and follow required reporting procedures.
By signing below, I acknowledge and agree to the following: I consent to required background checks, including fingerprinting; I grant permission for photographic and video use as outlined in the UAC photo release; and I understand and agree to follow UAC’s mandatory reporting requirements, including immediately notifying UAC leadership if I suspect abuse, neglect, exploitation, or risk of harm involving a youth.*

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