North Central Florida Ymca Volunteer Coach Application (Page 2 of 3) in pdf

North Central Florida Ymca Volunteer Coach Application Page 2

Have you ever been convicted, pleaded “nolo contender”, or had adjudication withheld for any crime or

offense other than a minor traffic violation? No __ Yes __ If so, what was it? ____________________

Signature Section

I certify that the information contained in this application is true and accurate to the best of my knowledge. I understand that

falsification of this application in any degree is ground for disqualification from volunteering. I understand that the YMCA will

conduct a background investigation through the local sheriff’s office. I hereby authorize this source to release information

about me, and understand that the YMCA may contact sources not listed herein. I agree to conform to the rules and policies of

the YMCA and understand that my volunteer status may be terminated if such rules are not abided by. I understand that the

YMCA does not carry accidental insurance and agree to use my personal insurance if needed. I agree not to hold the YMCA or

its staff, Board of Directors or sponsors responsible for injuries or accidents. I authorize the YMCA staff to obtain medical care in

the case of injury or accident if a parent or guardian is unavailable to give permission. It is hereby understood and agreed that

the YMCA does not have accident insurance or worker’s compensation insurance for volunteers.

Signature: __________________________________________

Date: __________________

YMCA Use Only:

Background check completed by (initials) _________

Date: _______________________

Sent to Director: ___________________________________________________________

Season: _________________

Year______________ Date: ______________________

North Central Florida Ymca Volunteer Coach Application Page 2