Volunteer/Coach Application

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LYBA CONSENT/RELEASE
LYBA VOLUNTEER APPLICATION SUBMISSION

LYBA VOLUNTEER APPLICATION

INSTRUCTIONS

This application must be completed by ALL volunteers, including, coaches, managers, administrators, umpires, etc. of the LYBA who have regular access to, or repeated contact, with athletes.

Please completed the entire application. A copy of a valid government issued photo ID is required to complete this application.

PERSONAL INFORMATION:

Full Legal Name*

Date of Birth*

Other Names (maiden, alias, nickname, etc.)

Social Security Number*

Please Select*

Male

Female

Driver's License Number*

Driver's License State*

Driver's License Expiration Date*

Home Phone Number*

Cell Phone Number*

Work Phone Number

Email Address*

Current Home Address*

List Previous Addresses for the Past 7 Years*

QUALIFICATIONS:

What position are you applying for?*

Have you ever been convicted of a crime?*

Yes

If YES, please explain.

Have you ever been refused participation in any other youth sports program?*

Yes

If YES, please explain.

Do you have children in the LYBA Program?*

Yes

If YES, please specify.

Please upload a copy of a valid government issued photo ID by clicking the "SELECT FILES" button below.

Max file size: 20.00 MB. | Allowed file types: PDF,JPG,JPEG,GIF,PNG,BMP | Min number of file: 1

Select Files

ACKNOWLEDGEMENT OF TRAINING:

I acknowledge that on the date specified below, I was given a copy of the Livingston Youth Baseball Association, Inc.'s (LYBA) Child Abuse/Molestation Risk Management Program and that I have carefully reviewed it and voluntarily agree that as a condition of future participation, employment, or involvement in this organization, I will abide by all the terms, conditions, policies, and procedures containd within this program..

If I violate the policies, regulations, or spirit of this program, I will indemnify and hold harmless LYBA, its employes, board members, volunteers, and officials from any and all liability including negligence and any intentional tort claims.

Please specify the date you received a copy of the LYBA Child Abuse/Molestation Risk Management Program.

Date*

Electronic Signature Agreement - By electronically entering your name below and submitting this form, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By submitting this form, you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse, or other device to select an item, button, icon or similar act/action, or to otherwise provide the Livingston Youth Baseball Association or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the Livingston Youth Baseball Association. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.

NAME*

DATE*

CANCEL

NEXT: CONSENT/RELEASE FORM

LYBA CONSENT/RELEASE

I authorize and give consent for Livingston Youth Baseball Association, Inc. (LYBA) to obtain my personal information.

This includes, but is not limited to employment records/employer's references, criminal background records/information, criminal background checks/fingerprints; driving record check, coaching experience, personal references, and addresses.

I authorize this information to be obtained either in writing, via internet, or via telephone in connection with my volunteer application.

I understand that my position is contingent upon adverse information about my background or character not being uncovered upon the performance of the above referenced checks. I also understand that regardless of my prior volunteer activities on behalf of the LYBA, that the LYBA is not required to allow my continued participation.

I agree to hold harmless and indemnify from liability the LYBA and its directors, officers, employees, and volunteers from all liability arising out of the use of the information that is uncovered in the above referenced checks.

NAME*

DATE*

CANCEL

NEXT: APPLICATION SUBMISSION

LYBA VOLUNTEER APPLICATION SUBMISSION

Thank you for your interest in volunteering with the LYBA. We will review your submitted application and contact you with the next steps. Please enter your name and date below to finalize your application.

Name*

Date*

CANCEL

SUBMIT VOLUNTEER APPLICATION

INSTRUCTIONS

PERSONAL INFORMATION:

QUALIFICATIONS:

Please upload a copy of a valid government issued photo ID by clicking the "SELECT FILES" button below.

ACKNOWLEDGEMENT OF TRAINING:

Please specify the date you received a copy of the LYBA Child Abuse/Molestation Risk Management Program.

LYBA CONSENT/RELEASE

LYBA VOLUNTEER APPLICATION SUBMISSION

Thank you for your interest in volunteering with the LYBA. We will review your submitted application and contact you with the next steps. Please enter your name and date below to finalize your application.

Your form has been submitted