Millbury Girls Softball Volunteer Application 2010 Season

Name__________________________________DOB_____________ Date________________
Address_______________________________________________Town______________________State________Zip___________
Home Phone ______________________Business Phone __________________
Occupation_________________________________ Employer_______________________________
Address_____________________________________________________________________
Special professional training, skills, or hobbies:
________________________________________________________________________________
Community affiliations (Clubs, Service Organizations, etc.):
________________________________________________________________________________
Previous volunteer experience (incl. softball and year):
________________________________________________________________________________
Do you have children in the program? Yes No If yes, at what level?
_____________________________________________________
Special Certification (i.e. CPR, Medical, etc.):
_________________________________________________________________________________
Are you ASA ACE certified Yes No (if you are planning on managing a team ACE level 1 certification is
required starting in 2010)
Would you be willing to take on line ASA ACE course Yes No (Re-imbursement provided with proof of
successful completion)
Do you have a valid driver’s license Yes No Drivers License# ____________________State ____________
Have you ever been convicted or plead guilty to any crime(s): Yes No
If yes, describe each in full on back.
Have you ever been refused participation in any other youth programs? Yes No
If yes, explain in full on back.
In which of the following would you like to participate? (Check all that apply)
Manager* Coach Parent Volunteer Board Member
Please list three references, at least one of which has knowledge of your participation as a volunteer in a youth
program:
Name Phone
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
As a condition of volunteering, I give permission for the Millbury Girls Softball organization to conduct a
background check on me, which may include a review of sex offender registries, 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
Millbury Girls Softball organization, the officers, and volunteers thereof, or any other person or organization
that may provide such information. I also understand that, regardless of previous appointments, Millbury Girls
Softball organization 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 Millbury Girls Softball organization policies or principles.

Applicant Signature _____________________________________________________ Date ______________________

Applicant Name (please print)________________________________________________________________________
NOTE: Millbury Girls Softball organization will not discriminate against any person on the basis of race, creed, color national origin,
marital status, gender, sexual orientation or disability.
Millbury Girls Softball Use Only:
Background check complete: