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Volunteer Coach’s Application

Conditions of volunteer service (Please read before completing this section and signing below)

You may answer NO if your criminal record only consists of one or more of the following: (a) a sealed record on file with the commissioner of probation, (b) your case is a case where you were determined to be delinquent or to be a child in need of services, which did not result in a complaint transferred to Superior Court for criminal prosecution, or (c) your crimes were misdemeanors and they occurred five or more years ago. Note: A conviction record will not necessarily be a bar to volunteer service.
Prior Experience
Please describe your previous coaching or relevant volunteering experience.
References
Please list three references.
Disclaimer and Signature
RELEASE, WAIVER OF LIABILITY AND INDEMNIFICATION
I certify that the statements made in this Volunteer Coach Application are true and correct and have been given voluntarily. I understand that I will not be paid for my services as a volunteer and I waive any claim to payment of wages. I further understand that I may be asked to discontinue my volunteer services at any time for any reason. I agree to abide by all laws and regulations applicable to Housatonic Youth Basketball (HYB) and demonstrate a readiness to help others, maintain healthy boundaries and always act in the best interests of the children who participate in HYB. I understand that volunteer service will be contingent upon approval from the HYB Board. Volunteer service is also contingent upon satisfactory results of a background check, including a criminal record check (CORI).

I hereby RELEASE, WAIVE AND DISCHARGE Housatonic Youth Basketball and HYB officials, organizers, sponsors, Board of Directors, coaches, referees, volunteers, other HYB participants, the Town of Great Barrington, Berkshire Hills Regional School District, Berkshire School, Berkshire South Regional Community Center and all of the facilities at which the League shall hold practice or play basketball (all of the foregoing being referred to herein as the ?Released Parties?), from all liability to me, my heirs, personal representatives, next of kin, estate, administrators and assignees for any and all loss or damage, and any claims or damages therefore, on account of any injury to my property resulting from participation as a volunteer of HYB or travel to/from HYB events. In addition, I hereby agree to indemnify and defend Released Parties and hold the Released Parties harmless from and against (1) any type of claim, complaint or charge made against the Released Parties as a result of my actions; (2) all damage, claims, injury or loss that may be incurred by any of the Released Parties as a result of my actions. I hereby give the Released Parties the right to include my name and/or photograph in any website, video recording or still photograph which they may create, or have created, including publication or dissemination over the internet.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE AND WAIVER OF LIABILITY AND A CONTRACT OF INDEMNITY GOVERNED BY MASSACHUSETTS LAW.
By entering your name below, you are agreeing to the terms outlined herein and attesting to the completeness of your answers above.
 

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