Volunteer Application

Personal Information

Name*

First Last

Email*

Primary Phone*

Hidden

Business Phone

Birth date*

Age*

Driver's License No.

State

Father/Guardian Name (if you are a minor)

First Last

Father/Guardian Phone

Father/Guardian Email

Mother/Guardian Name (if you are a minor)

First Last

Mother/Guardian Phone

Mother/Guardian Email

Emergency Contact*

First Last

Emergency Phone*

Physician Name

First Last

Physician Phone

Physician Email

Medical Insurance Carrier*

Coverage Number

Carrier Business Phone

Questionnaire

Some questions are optional

Which E-Sports program will you volunteer at?*

E-Soccer
E-Karate
E-Hoops
E-Fitness
E-Dance
E-Football

Which E-Sports location?*

What volunteer position(s) in the E-Sports Program is the volunteer applying for?

What experience has the volunteer had working with children, including children with special needs, in the position(s) the volunteer is applying for?:

Has the volunteer worked with children in other sports programs, including public entities, private nonprofit or other organizations?*

No
Yes

If Yes, please provide the name, address, dates of service, description of work and contact information (telephone, email and fax) for the entities, organization(s) and the person(s) who supervised you, so that we may contact them for references.

As part of the application process, do you agree to allow the E-Sports Program to conduct a criminal records background check to help determine the applicant’s suitability to work with children in the position(s) the volunteer is applying for?*

No
Yes

To complete the background check, please 1) read the brief BACKGROUND INVESTIGATION CONSENT below and check the box, then 2) complete the free online background investigation form at https://www.ministryopportunities.org/baccpaloalto. (This basic form takes only a few minutes to complete. All personal information will be kept confidential and will not be used for any purpose other than the background investigation.) BACKGROUND INVESTIGATION CONSENT: I, the undersigned Applicant (also known as “consumer”), hereby authorize Bay Area Christian Church Exceptional Children Sports Program (also known as “BACC E-Sports”) and/or its agents and/or contractors to conduct an independent investigation and procure background information on me (also known as a “consumer report and/or investigative consumer report”), prior to, and at any time during, my service as a volunteer with BACC E-Sports. This report may include a social security number verification, present and former addresses, criminal and civil records/history and state sex offender records, and police records for the purpose of obtaining information which may be relevant or material to my qualifications as a volunteer worker working with or having contact with children in the BACC E-Sports Program. In consideration of the receipt and evaluation of my application by the BACC E-Sports Program, I hereby release the E-Sports Program, BACC, its officers, directors, employees and volunteers, which provide information pursuant to this authorization and release, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family. I understand that I am entitled to a complete copy of any background information report of which I am the subject made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act (also know as “FCRA”). The following information is true and correct to the best of my knowledge. I further state that I HAVE CAREFULLY READ THE FOREGOING AUTHORIZATION AND RELEASE, KNOW THE CONTENTS THEREOF, AND I SIGN THIS AUTHORIZATION AND RELEASE AS MY OWN FREE ACT. This is a legally binding agreement, which I have read and understand.

I acknowledge that I have read the BACKGROUND INVESTIGATION CONSENT and accept the terms stated therein

Does the volunteer applicant have any special needs that the E-Sports program should be aware of in regard to participation in the Program?

No
Yes

If Yes, please describe:

Has the volunteer applicant ever been diagnosed by a medical doctor with allergies, asthma, hemophilia, heart condition, history of respiratory illness, or other significant medical condition?*

No
Yes

If Yes, please state problems:

AUTHORIZATION, RELEASE AND CONSENT

EMERGENCY AUTHORIZATION: I, the undersigned adult volunteer applicant, or the parent or legal guardian of the minor volunteer applicant, hereby authorize the person(s) leading or directing E-Sports Program of the Bay Area Christian Church activities or events, including coaches, instructors, other volunteers, the above identified emergency contact and/or other E-Sports Program officials, to use their best judgment and act as my agent(s) in obtaining medical, dental or surgical attention and/or treatment, for me or the minor volunteer applicant, should such attention or treatment become necessary and appropriate under the circumstances, as a result of my or the minor volunteer applicant’s participation in E-Sports Program activities or events. In granting this permission, it is expressly understood that any expenses incurred by or on behalf of me or the minor volunteer applicant for such treatment and/or attention, are my sole responsibility and I represent and warrant that I have valid health care coverage and/or the financial ability to pay for such expenses.

ASSUMPTION OF RISK: I, the undersigned adult volunteer applicant, or the parent or legal guardian of the minor volunteer applicant, for myself and/or on behalf of the minor volunteer applicant, our heirs, assigns and next of kin, acknowledge that participation in E-Sports Program of the Bay Area Christian Church activities or events involves risk of physical injury, sickness from infectious disease, and possible death. For myself, and/or on behalf of the minor volunteer applicant, our heirs, assigns and next of kin, we willingly and voluntarily accept and assume all such risk.

WAIVER, RELEASE AND INDEMNIFICATION: In consideration of E-Sports Program of the Bay Area Christian Church permitting the me and/or the minor volunteer applicant to participate in its programs, I, the undersigned adult volunteer applicant, or the parent or legal guardian of the minor volunteer applicant, for myself and/or on behalf of the minor volunteer applicant, our heirs, assigns and next of kin, hereby waive all claims and release, discharge, agree to hold harmless and indemnify E-Sports Program of the Bay Area Christian Church, its board of directors, officers, employees, volunteers, officials, sponsors and other representatives from any and all actions, claims, costs, expenses and demands of every kind and description including, but not limited to, personal injury, sickness, property damage and death, based on negligence, contract claim or other legal theory, arising out of, during or in any way related my and/or the minor volunteer applicant’s participation in E-Sports Program activities or events.

PERSONAL INFORMATION - CONSENT, WAIVER AND RELEASE: I, undersigned adult volunteer applicant, or the parent or legal guardian of the minor volunteer applicant, for myself and/or on behalf of the minor volunteer applicant, our heirs, assigns and next of kin, hereby consent and give permission to E-Sports Program of the Bay Area Christian Church to take and compile sport related photographs, film, video and/or audio clips of me and/or the minor volunteer applicant and to use them, along with my name and/or the name of the minor volunteer applicant, as well as sport related personal information about myself and/or the minor volunteer applicant, in any printed material, film, video, audio or other medium, including CD, Internet or other electronic media, describing, advertising or promoting the E-Sports Program. In consenting to such uses, we hereby waive the right to inspect and approve the images and information used, as well as all rights to compensation. We further release E-Sports Program of the Bay Area Christian Church from any and all claims regarding use of the images or information, including, but not limited to, claims related to defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright.

I HAVE READ THE ABOVE EMERGENCY AUTHORIZATION, ASSUMPTION OF RISK, WAIVER, RELEASE AND INDEMNIFICATION AND PERSONAL INFORMATION -CONSENT, WAIVER AND RELEASE, AND I FULLY UNDERSTAND THE TERMS OF EACH. I FURTHER UNDERSTAND THAT THE MINOR VOLUNTEER APPLICANT AND/OR I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING THIS FORM AND AGREEING TO THESE TERMS. I AM AWARE THAT THIS FORM IS A LEGALLY BINDING AND ENFORCEABLE AGREEMENT, AND I SIGN THIS FORM AND AGREE TO THESE TERMS FREELY AND VOLUNTARILY, WITHOUT INDUCEMENT FOR MYSELF, AND ON BEHALF OF MYSELF AND/OR THE MINOR VOLUNTEER APPLICANT.

I acknowledge that I have read the Authorization, Release and Consent form and accept the terms stated therein

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Thanks for your interest in volunteering for E-Sports!

We appreciate your desire to get involved with E-Sports. Please complete the following application to get started.

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AUTHORIZATION, RELEASE AND CONSENT

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