First Name

Last Name

Address

City

State

Zip

Cell Phone

Home Phone

Email Address

SSN

Date of Birth

Occupation

Employer

Work Phone

Employer City

Employer State/Zip

Special professional training, skills, hobbies, etc.:

Special Certifications (CPR, Medical, etc.):

Baseball Experience (type and years)

Do you have children in the program? Do you have children in the program? Yes No

Please list name(s), age(s), and division(s):

Have you ever been convicted of a felony offense? Have you ever been convicted of a felony offense? Yes No

Please explain in full detail:

Have you ever been convicted of any crime that requires you to register as a sex offender? Have you ever been convicted of any crime that requires you to register as a sex offender? Yes No

Please explain why:

Have you ever been refused participation in any other youth program? Have you ever been refused participation in any other youth program? Yes No

Please explain why:

In which of the following would you like to participate (check one or more)? In which of the following would you like to participate (check one or more)? Manager Coach Team Parent Umpire Field Help Other

Explain Other:

Background Check Agreement Background Check Agreement As a condition for volunteering, I give my permission for Griffith Youth Baseball to conduct a background check on me, which may include a review of sex offender registries, child abuse, and criminal history records. I understand that, if appointed, my position is conditional upon the league receiving no inapporopriate information on my background. I hereby release and agree to hold harmless from liability the Griffith Youth Baseball League, the officers and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, Griffith Youth Baseball is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board of Directors for violation of Griffith Youth Baseball League policies and principles.

Submission Agreement Submission Agreement By submitting this form, I certify that all the information provided is correct and I have disclosed all information required for this background check.