Volunteers

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PERSONAL INFORMATION

We just wanted to say thank you for your interest in volunteering with Momentum Youth Athletics. We appreciate your support in helping young athletes achieve their goals.

Full Name *

First

Last

Date of Birth *

Driver's License or Identification Number *

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email

Gender

Are you bilingual?

Yes
No

Language

EMERGENCY INFORMATION/CONTACT

Is there a medical condition that we should be aware of in case of emergency?

Yes
No

If Yes, please explain.

Emergency Contact Name *

First

Last

Emergency Contact Phone

Emergency Contact Email

EMPLOYMENT INFORMATION

Name VOLUNTEER Are

Name of Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Position

Supervisor Name *

First

Last

Supervisor Phone Number

Supervisor Email

REFERENCES

Only one can be a family member.

Reference 1. Name *

First

Last

Phone

Email *

Reference 2. Name *

First

Last

Phone

Email *

ELIGIBILITY CHECKLIST

Failure to disclose information accurately and thoroughly is basis for disqualification.

Have you ever been convicted of a felony crime? Include any pending charges.

Yes
No

Have you been convicted for use/possession of any controlled substance?

Yes
No

Do you have any convictions with elements of violence within the last 5 years?

Yes
No

Do you have any convictions relating to the discharge/possession of any weapons?

Yes
No

Do you have any convictions or admissions of falsifying public records?

Yes
No

Have you ever been convicted of any sex offense? Include any pending charges.

Yes
No

Are you presently on probation, formal or informal, or diversion?

Yes
No

Have you been convicted of driving under the influence in the last 5 years?

Yes
No

VOLUNTEER DETAILS

Volunteer Position Applying For. *

Coach/Trainer
Administrative
General Support

Which days of the week are you available?

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
No Preference
TBD

What time of day do you prefer?

Morning
Afternoon
Evening

What are your areas of interest?

Sports
Community Service
Nutrition
Educational
Virtual
Mentorship

T-shirt Size

Small
Medium
Large
Extra Large
2XL
Other

Describe your skills and qualifications:

VOLUNTEER AUTHORIZATIONS

Background Check *

I hereby authorize Momentum Youth Athletics LLC, or any authorized representative, to obtain any information pertaining to the completed, attached application to determine my qualifications for a volunteer position within Momentum Youth Athletics LLC. I authorize said representatives to utilize the information contained therein to conduct a background investigation appropriate to the level of scrutiny regarding the position I am applying.

Confidentiality *

No volunteer shall divulge confidential information, data, records of Momentum Youth Athletics LLC to any person to whom issuance of such data, information, or records has not been authorized. Violators will be prosecuted and may additionally be subject to civil legal action by the person who had their right to privacy violated. Violations may also result in criminal legal action. Any volunteer who is responsible for such misuse is subject to dismissal.

Hold Harmless Agreement *

The undersigned, not being a permanent employee of Momentum Youth Athletics LLC, hereby agrees to hold harmless, indemnify, and defend Momentum Youth Athletics LLC, its affiliates, officers, employees, and agents from any and all claims, demands, actions, or causes of action arising out of or related to the Volunteer’s activities or participation in the organization’s programs.

Signature *

Clear Signature

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