Coach / Volunteer Application
Today's Date
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Month
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Day
Year
Date
Full Legal Name
First Name
Middle Name
Last Name
Previous / Maiden Name(s)
Name
Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Date of Birth
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Month
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Day
Year
Date
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number
Please enter a valid phone number.
Gender
Male
Female
T-Shirt Size
Adult SM
Adult M
Adult L
Adult XL
Adult XXL
School
Years of Coaching Experience
Special Certifications(CPR, Medical, etc)
Valid Driver's License
Yes
No
Driver's License #
State:
Have you ever been convicted of or plead guilty to any crime(s)
Yes
No
If yes, describe each in full
Are there any criminal charges pending against you regarding any crime(s)
Yes
No
If yes, describe each in full
Have you ever been refused participation in any other youth program(s)
Yes
No
By completing this form I acknowledge and agree to abide by all rules, policies and regulations of the New Albany Track Club, Corp. I also understand that, regardless of previous appointments, New Albany Track Club, Corp. is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board of Directors for violation of NATC policies or principles. While in good standing, and barring removal or suspension as described, I will become a member of the New Albany Track Club, Corp. with membership expiring annually on August 1. I understand that all positions are volunteer and that I have no employment relationship with the New Albany Track Club, Corp
Criminal Background Screening Acknowledgment
All background checks must be on file for every volunteer or coach before that individual may participate in any NATCactivities. As a pre-condition to serving as a NATC Volunteer or Volunteer Coach, I give permission to the New Albany Track Club, Corp., or its agent, to conduct a criminal background screening on me, which may include a review of sex offender registries, child abuse, and criminal history records. I hereby release and hold harmless from liability the New Albany Track Club, Corp., the officers, employees, agents, volunteers thereof, and any other person, organization, orentity that may provide such information.
Signature
Date Signed
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Month
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Day
Year
Date
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