Minor Coaches/unified Partner/ A Volunteer Application (Page 2 of 2) in pdf

In the course of volunteering for Special Olympics, I may become aware of personal information, and I agree to keep said information in the

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strictest confidence.

I grant Special Olympics New Mexico permission to use my likeness, voice and words in television, radio, film or any form to promote

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activities of Special Olympics.

I understand that the relationship between Special Olympics New Mexico and volunteers is an “at will” arrangement and that it may be

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terminated at any time, without cause, by either the volunteer or Special Olympics New Mexico.

Youth Applicants must have this form signed by a parent or guardian.

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Youth Applicants must submit two(2) signed Minor Reference Forms (attached).

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I affirm that I have read both pages of this Application and understand its meaning. I also affirm the information I have given is true

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and complete.

Applicant Signature:_____________________________________________________Date:___________________

Parent /Guardian Signature:____________________________________________________Date:___________________

Minor References

By signing below, I confirm the following:

know________________________Name of

Applicant___(“Applicant”) in either a personal or professional capacity.

I am at least 18 years of age and am not a legal guardian or relative of Applicant.

I am not aware of any reason that Applicant should not be permitted to volunteer on behalf of Special Olympics New Mexico.

I do not possess any information that would cause me to believe Applicant would pose any undue risk to Special Olympics athletes or

others who participate in Special Olympics.

Reference #1

Printed Name:___________________________________________________________________________

Signed:_________________________________________________ Date:__________________________

Relationship to Applicant:__________________________________________________________________

Address:__________________________________________ City:_________________________________

State:________ Zip:_____________________ Phone:__________________________________________

Reference #2

Printed Name:___________________________________________________________________________

Signed:_________________________________________________ Date:__________________________

Relationship to Applicant:__________________________________________________________________

Address:__________________________________________ City:_________________________________

State:________ Zip:_____________________ Phone:__________________________________________

Note – A minor “background check” will expire upon their 18

birthday. At that time another background check must be

submitted to continue volunteering with SONM. SONM reserves the right to contact a minors references throughout their

volunteer time and may choose to ask the minor to no longer volunteer based on this information.

Updated 9/3/2014

Minor Coaches/unified Partner/ A Volunteer Application Page 2