Adaptive Sports For Kids Registration Form

Your Full Name*

First NameLast Name

Date of Birth*

Date

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Date

Occupation*

Employer*

Special professional training, skills, hobbies*

Community affiliations (Clubs, Service Organizations, etc.*

Previous Volunteer Experience *

Special Certification (CPR, Medical, etc.)*

Do you have a child/children in the program*

If yes, please state the child/children's name(s)

Have you ever been convicted of or plead guilty to any crime(s)?Do you have a child/children in the program*

If yes, describe in full

Which of the following would you like to volunteer for?*

Date*

Date

Any additional information you would like to provide?

Please list three references, including name and phone number*

AS A CONDITION OF VOLUNTEERING, I give permission for Adaptive Sports for Kids, Inc. (ASK), 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 records. I understand that, if appointed, my position is conditional upon ASK receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability ASK, the officers and any volunteers of ASK thereof, or any other person or organization that may provide information. I also understand that, regardless of previous appointments, ASK 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 removed by the Board of Directors for violation of ASK policies and principles.Note: ASK will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability.*

VERY IMPORTANT! Sign up for Text Message Alerts! Simply Text @ADAPTIVES to 469-645-0101 - You will receive a text message asking for your name. Simply reply with your “name” (i.e., Kerri May) and you will start receiving notifications.

Adaptive Sports for Kids was formed in December, 2011. Our goal is to give children and young adults with disabilities the opportunity to play sports they may not otherwise be able to play, all at no charge to them. Since many of our players are in wheelchairs, walkers, or just have balance issues, certain equipment is needed in order to give them the chance to play. We rely strictly on donations to supply this special equipment. We are Chapter 501 (c )(3) tax exempt.

Adaptive Sports For Kids Volunteer Form