Holbrook Regional Recreation Department

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Holbrook Regional Recreation Volunteer Application

* Date:

* First Name:

* Middle Initial:

* Last Name:

* Date of Birth:

* Current Address:

* # of years at current address:

* Phone:

* email:

* Please list any other addresses you have legally resided at during the past five years:(included number of years at each residence:

* Have you ever been convicted of or plead guilty to any Class A, B or C crime(s)? Yes or No:

* Are there any criminal charges pending against you regarding any crime(s) involving or against a minor? Yes or No:

As a condition of volunteering, I give permission for Holbrook Recreation to conduct a background check on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries, and criminal history records. I understand that, if appointed, my position is conditional upon the organization receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the Holbrook Recreation, the towns of Clifton, Eddington, Dedham, and Holden, employees and volunteers thereof, or any other person or organization which may provide such information. I also understand that regardless of previous appointments, Holbrook Recreation is not obligated to appoint me to a volunteer position.

* Signature:_____________________________________:

Note: Holbrook Recreation will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability.

HOLBROOK RECREATION USE ONLY:
Background check completed by Holbrook Recreation Committee Member ________________________ on ____________________.

Reviewed by_____________________________ on _________________________.

System Used: InfoME

_______Applicant is eligible to participate in Holbrook Recreation Programs

* indicates required fields

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Holbrook Regional Recreation Volunteer Application