Moultrie YMCA Volunteer Application
Date of Application __________________
Name _____________________________________________________________________ Date of Birth ___________________
Address _________________________________________________ City ______________________________ Zip _______________
Email Address __________________________________________________________________________________
Cell Phone ______________________________ Home Phone ____________________________
Name of Employer ___________________________________________________________________________
Can you be contacted at work? _____________
Work Phone ___________________________
For the protection of the children we serve, we must ask if you have ever been convicted of a felony or
misdemeanor. If so, please explain ________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
List the name and phone number of two references. (Non-family)
1. _______________________________________________________________________________________________________________________
2. _______________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Sports Volunteer Only
What is your philosophy of youth sports? ________________________________________________________________________
__________________________________________________________________________________________________________________________
Why do you want to coach? _________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Mentoring Volunteer Only
What day and time are you interested in Mentoring?____________________________________________________________
School Preference? ___________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
I understand that if I am selected to volunteer I will be governed by the rules and policies of the
Moultrie YMCA. This includes successfully completing a background check. Failure to pass a
background check will result in the loss of volunteer privileges.
I give the Moultrie YMCA permission to take pictures of me during daily interactions associated with
the Moultrie YMCA and use them for publications such as but not limited to: The Moultrie Observer,
Facebook, Newsletters and Flyers.
(Please wait to sign in front of YMCA Director.)
Signature __________________________________________________________________________ Date __________________
YMCA Director ____________________________________________________________________ Date __________________