Volunteer

Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Program you are interested in *

Outing Club

Soccer

Pee Wee Basketball

Shooting Stars Basketball

Cheering

Baseball

Softball

Ski / Snowboard

Have you ever been convicted of or plead guilty to any Class A, B or C crime(s) *

YES

NO

Are there any criminal charges pending against you regarding any crime(s) involving or against a minor? *

YES

NO

As a condition of volunteering, I give permission for Holbrook Recreation to conduct a background check on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries, and criminal history records. I understand that, if appointed, my position is conditional upon the organization receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the Holbrook Recreation, the towns of Clifton, Eddington, Dedham, and Holden, employees and volunteers thereof, or any other person or organization which may provide such information. I also understand that regardless of previous appointments, Holbrook Recreation is not obligated to appoint me to a volunteer position. *

YES

NO

Today's Date *

MM

DD

YYYY