West Chicago Youth Cheerleading Organization - (West Chicago, IL)

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Cheer Parent Committee

Date:

Position:

* Squad/Grade:

* Full Legal Name of Applicant:

* Address:

* Gender:

* Home Phone:

Work Phone:

* Cell Phone:

* Email:

Date Of Birth:

Drivers License Number:

State:

Exp. Date:

Previous Address (Please list if not at current address for 5 years or longer

Address:

References (Please list 3 who are not family members)

* Name #1:

* Phone Number:

* Name #2:

* Phone Number:

* Name #3:

* Phone Number:

* Have you ever been arrested, charged, or convicted of a crime?:

YES

* If YES, please explain:

* Have you ever or currently have a problem with drugs and/or alcohol:

YES

* If YES, please explain:

Have you ever coached before? If so, when, where, and how long?:

* What is your motivation in volunteering for this position?:

List any formal training that you have completed that is related to this position:

Are there any other considerations you would like to note? (Possible assistant coaches or co-coaches, etc.):

I understand and agree that:

1. The West Chicago Youth Cheerleading Organization board members have the final decision on coaching applications.

2. This application is valid for ONE cheerleading season.

3. By submitting this application, I, the applicant, agree (in return for being permitted to volunteer) that if any of the foregoing information is INCORRECT, I will forever indemnify and hold the West Chicago Youth Cheerleading Organization harmless for any acts or omissions on my behalf as they relate to any incorrect information I have provided.

4. By submitting this application, I, the applicant< voluntarily waive my privacy rights to the extent necessary for the West Chicago Youth Cheerleading Organization to verify the foregoing information through any reasonable means, including, but not limited to local, state, national, and international criminal background check(s) and to inform those within the West Chicago Youth Cheerleading Organization who are responsible for accepting and?or supervising volunteers.

5. By submitting this application, you agree to participate in an interview with the current board.

Check this box if you agree with the conditions listed above *

check this box to provide your electronic signature *

* Type Your Name:

Signature:

Date:

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