Conococheague Little League

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Volunteer Form

A COPY OF A VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE TURNED IN TO COMPLETE APPLICATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Social Security Number:

Cell Phone:

* Home Phone:

* Email Address:

* Date of Birth:

Occupation:

Employer:

Employer Address:

Special Professional training, skills:

Community Affiliations (Clubs, Org):

Previous Volunteer Experience (include baseball/softball):

Special Certification (CPR, Medical):

* Do you have children in the program?:

If Yes, list full name:

If Yes, list level:

* Do you have valid driver's license::

* Driver's License #::

* State::

* Have you ever been convicted of or plead guilty to any crime involving a minor?:

If Yes, describe in full::

* Are there any criminal charges pending against you regarding any crime involving a minor?:

If Yes, describe in full::

* Have you ever been refused participation in any other youth programs?:

If Yes, explain:

In which of the following would you like to participate? (check one or more)

Coach

Manager

Scorekeeper

Umpire

Concession Stand

Field Maintenance

League Official

Computer Skills / Website Editing

Other Area:

Please list 3 references, at least one of which has knowledge of your participation as a volunteer in a youth program:

* Reference #1 Name:

* Reference #1 Phone:

* Reference #2 Name:

* Reference #2 Phone:

* Reference #3 Name:

Reference #3 Phone:

AS A CONDITION OF VOLUNTEERING. I give permission for the Little League organization to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registeries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records.

I understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the local Little League, Little League Baseball, Incorporated, the officers, employees and volunteers, thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, Little League is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board of Directors for violation of Little League policies or principles.

Checking this box verifies all above information is true to your knowledge *

* Signature of Parent/Guardian (Electronic):

* Date:

* indicates required fields

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