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CITY OF BRIGHTON We appreciate your interest in volunteering for our community. In order to insure that we select the most qualified volunteers for our programs AND to insure the safety of our children and adults participating in these programs, we request that you complete all sections of this volunteer application. Full Name (First, MI, Last): Home Telephone Work Telephone ( ) ( ) Street Address: City, State, Zip Code Social Security Number: Date of Birth (Mo/Day/Yr): Have you ever been known by another name? YES NO If YES, indicate below: What sport are you interested in coaching? What is the name/age of the child your interested in coaching? TIME OF DAY SUN MON TUE WED THU FRI SAT Morning Afternoon Evening Please mark the months you wish to volunteer. January March May July September November February April June August October December The City of Brighton does not place volunteers in positions of direct supervision by a relative. Please list any relatives (including spouse) employed by the City of Brighton. List your current or last position including your dates of hire/termination, name/address of employer, telephone number, supervisor's name, and a brief description of duties. From To (Mo/Yr): (Mo/Yr): VOLUNTEER COACH APPLICATION Email Address Please indicate day(s) and time(s) you are available to volunteer WORK EXPERIENCE Name of Company Description of Duties: Street Address, City, State, Zip Code Telephone Number (Include Area Code) Supervisor's Name ---PAGE BREAK--- Please note dates, types, places of experience, immediate supervisor's name and telephone number: Contact Name: Relationship: Street Address, City, State, Zip Code: Home Telephone Number: ( ) Work Telephone Number: ( ) Have you ever been charged with a crime that resulted in plea of guilty, no contest, deferred judgment, deferred prosecution or convixtion of any law violation (except minor traffic violations? YES NO If YES, list for each conviction: date of offense; charge; jurisdiction; court name, and disposition. Have you ever been involved in an incident involving child/elder abuse or child/elder neglect? YES NO If YES, please explain below: I certify that the information in this application is true and complete. I understand that false statements, misrepresentations or omissions of information in this application may result in rejection of this application. The City is expressly authorized to investigate all statements contained in this application. I consent to the release of information about my ability and fitness for volunteer assignment by employers, schools, law enforcement agencies, and other individuals and organizations to investigators, personnel staffing specialists, and other authorized employees of the City of Brighton. In the event that I am selected to become a volunteer for the City of Brighton, I agree to comply with all of its ordinances, rules, and regulations. I fully understand and agree to provide my services to the City of Brighton as a volunteer in a voluntary capacity and that I will receive no compensation or benefits for services provided. As a participant, I understand that the above described activities may involve risks of injury, loss or damage to myself, including, but not limited to bodily injury, personal injury, sickness, disease, death, and property loss or damage. By signing this agreement, as a volunteer, I expressly agree to assume any and all such risks. In addition, in consideration for being permitted to perform the above described activities, as a volunteer, I hereby expressly exempt and release the City, its officers, employees, insurers, and self-insurance pool, from and against all liability, claims and demands, on account of injury, loss, or damage to myself, including without limitation claims arising from bodily injury, personal injury, sickness, disease, death, or property loss or damage, that I may incur as a result of being upon the premises of the City or as a result of performing the above described activities, whether any such liability claims, and demands result from the act, omission, negligence, or other fault on the part of the City, its officers, or its employees, or from any other cause whatsoever. Volunteer's Signature: Date: If Volunteer is Under 18, Signature of Parent/Guardian: Date: FOR CITY USE ONLY Reviewed by Comments: VOLUNTEER EXPERIENCE EMERGENCY NOTIFICATION INFORMATION BACKGROUND SIGNATURE, CERTIFICATION, RELEASE OF INFORMATION, AND RELEASE OF LIABILITY By Signing Below, I agree that I understand and consent to the above statement: ---PAGE BREAK--- Police Background: Sex-Offender Registry: Fingerprint Check: I understand that my responsibilities as a volunteer coach are of great importance and that my actions potential to significantly influence the young athletes whom I coach. Therefore, I promise to uphold the following rights of young athletes to the best of my ability. 1. The right to participate in sports. 2. The right to participate at a level appropriate to each child's maturity and ability level. 3. The right to receive qualified adult leadership. 4. The right to play as a child and not as adult. 5. The right to share in the leadership and decision-making of their sport. 6. The right to participate in a safe and healthy environment. 7. The right to proper preparation for participation in sports. 8. The right to an equal opportunity to strive for success. 9. The right to be treated with dignity. 10. The right to have fun in sports. I also promise to conduct myself in accordance with the Code of Ethics for Coaches as given below. 1. I will treat each player, opposing coach, official, parent and administrator with respect and dignity. 2. I will do my best to learn the fundamental skills, teaching and evaluation techniques and strategies 3. I will become thoroughly familiar with the rules of my sport. 4. I will become familiar with the objectives of the youth sports program with which I am affiliated and to achieve these objectives and communicate them to my players and their parents. 5. I will uphold the authority of the officials who are assigned to my sport and I will assist them , in eve to conduct fair and impartial competitive games. 6. I will learn the and weaknesses of my players so that I might place them into situations w have a maximum opportunity to achieve success. 7. I will conduct my practices and games so all players have an opportunity to improve their skill level active participation. 8. I will communicate to my players and their parents the rights and responsibilities of individuals on o 9. I will protect the health and safety of my players by insisting that all the activities under my control a conducted for their and physiological welfare, rather than for the vicarious interests o 10. I will adhere to all Brighton Parks and Recreation Department policies and procedures. With my signature, which I voluntarily affix to this contract, I acknowledge that I have read, understood my best to fulfill the promises made herein. Sport Signature of Coach CITY OF BRIGHTON VOLUNTEER YOUTH COACHING CONTRACT ---PAGE BREAK--- Date Signature of Coordinator