Maine Adaptive Volunteer Application

We appreciate your interest in our organization. Applications are received and volunteers are accepted without regard to race, creed, color, sex, religion, age, national origin, or physical or cognitive disability.

Name

First NameLast Name

Email address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth(MM/DD/YYYY)

MonthDayYear

If you feel comfortable sharing, how do you describe your gender identity? This information is for internal purposes only, as we try to find volunteers that reflect our students’ lived experiences.

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Have you been convicted of a felony (excluding any record or conviction that has been judicially sealed, expunged, eradicated or dismissed)

If yes, please explain (a conviction will not necessarily disqualify your application):

Have you ever been charged with child neglect or abuse?

Have you ever been found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person or to have abused or financially exploited any vulnerable adult?

If yes, please explain:

Are you a military veteran?

Branch

Years Served (XXXX-XXXX)

Are you employed?

Current Job/Occupation

Present Employer/Company

Are you currently in school?

School

Major

Please tell us why you’d like to volunteer for Maine Adaptive.

Are you interested in transporting participants from your area who may need a ride?

May we put your name, email address, and phone number on a list available to all Maine Adaptive volunteers?

Will you have a season pass for the upcoming ski season? If yes, which type.

Areas of Interest: We need volunteers in all of the following areas. Please check all areas in which you have interest.

Please categorize yourself as beginner, intermediate or advanced in the activities you identified experience in above.

Tell us more about your availability (weekends, weekdays, summer, winter, etc).

What draws you to volunteering with Maine Adaptive in your chosen sport, and what personal experiences, skills, or interests have shaped your desire to get involved in that specific activity?

Check any current professional certifications you have from the list below.

Please describe any experience that you have had with American Sign Language(ASL).

Please indicate if you have had experience working with people with any of the following disabilities:

Please check any adaptive equipment or techniques you have had experience working with:

Reference 1 Name:

Email address:

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Reference 2 Name:

Email address:

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Reference 3 Name:

Email address:

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name and Phone Number

I have read and agree to the following: Volunteer service is contingent upon the completion of a background investigation and reference check satisfactory to Maine Adaptive Sports and Recreation (MASR) in its sole discretion (“Background Check”). The applicant agrees to submit all required documentation and take all action required in connection with the completion of the Background Check and reference check. I acknowledge that I am not a volunteer of MASR until the organization has received notification that the Background Check and reference check has been completed to the satisfaction of MASR in its sole discretion. MASR shall exercise its best efforts to furnish accurate Services to Client. Notwithstanding the foregoing, MASR, its officers, employees, agents, successors and/or suppliers shall not be held liable for any claim, injury, or damage which may relate to, or otherwise arise from the furnishing of such Services unless MASR or its officers, employees, agents, successors and/or suppliers are negligent or fraudulent in the Provisioning of such Services to the Client. The Client shall indemnify, defend and hold MASR harmless from and against any and all costs, damages and liabilities, which may be asserted against MASR relating to, or arising from the improper use by the Client of information furnished to the Client by MASR and the National Center for Safety Initiative (NCSI). It is further agreed that the Client shall release MASR, its officers, employees, agents, successors and/or suppliers from any and all liability if there is an error or omission in the information received from third party sources.

As a volunteer applicant for Maine Adaptive I understand that MASR is one organization with multiple locations. I will travel to the location deemed necessary in order to help more individuals living with a disability get outside and break boundaries.

Maine Adaptive Volunteer Application

Personal Information: