Coach Application

* Required field
* Affiliate
* First Name
Middle Name
* Last Name
Are you volunteering through HandsOn Bay Area?
Are you volunteering through New York Cares?
* Date of Birth
* Home Address 1
Home Address 2
* Home City
* Home State
* Home Zip code
* Email address
* Confirm Email address
* Password (for online registration)
* Confirm Password
* Cell phone
Evening phone
Daytime phone
Daytime phone ext.
What is your highest level of education?
Major
Graduation Year
HighSchool/College attended or attending
Are you employed?
Yes No
* Employer
Position at Company
Employer Address 1
Employer Address 2
Employer City
Employer State
Employer Zip Code
Does your employer offer matching contributions for nonprofit donations or volunteer work?
Skills/Experience
Other Skills/Experience
Experience working with disabled youth
Yes No
Please describe
Previous volunteer experience
Yes No
Please describe
Languages (check all that apply)
Other Language
How did you hear about us?
How did you hear about us - Other
In Case of Emergency (ICE) Contact Information
* Emergency contact name
* Emergency contact phone
Agreement to Be Subject to KEEN Volunteer Screening and Monitoring Procedure

The safety and welfare of the children and young adults with disabilities who take part in KEEN's activities are of paramount concern to us. In order to safeguard the children and to ensure the involvement of outstanding volunteers, KEEN uses the following procedures:


1. At least 3 reference checks are completed for all volunteers. As part of these reference checks, a series of questions is asked to inquire about the suitability of individuals who seek to participate as volunteers in KEEN's programs. In the event a reference check suggests that an individual is not appropriate for service as a volunteer, this volunteer will be asked to refrain from further participation in the program.

2. KEEN reserves the right to terminate a volunteer for any reason.

3. All of the organization's decisions regarding a volunteer's participation shall be made on a non-discriminatory basis and without regard to race, gender, age, disability, religion, sexual orientation and/or national origin.


Agreement to Be Subject to KEEN Volunteer Screening and Monitoring Procedure


I hereby acknowledge that I have received a copy of (or access to) KEEN's Volunteer Screening and Monitoring Policy (located here) and confirm that I have read and understand the terms of the Volunteer Screening and Monitoring Procedure. I agree as part of the KEEN volunteer application process, to be subject to the terms of the KEEN Volunteer Screening and Monitoring Procedure, including the reference check process outlined above.

* I agree to be subject to the KEEN Volunteer Screening and Monitoring Procedures and to provide complete and truthful information in connection with the KEEN application and Volunteer Screening and Monitoring Procedures.
References
Please list three persons over age 18 as personal references who have known you for at least one year and your relation to them e.g. coworker, friend, teacher, etc. Please do not list family members or relatives.
Reference 1
* Reference 1 First name
* Reference 1 Last name
* Reference 1 Phone
* Reference 1 Email
* Reference 1 Relationship
Reference 2
* Reference 2 First name
* Reference 2 Last name
* Reference 2 Phone
* Reference 2 Email
* Reference 2 Relationship
Reference 3
* Reference 3 First name
* Reference 3 Last name
* Reference 3 Phone
* Reference 3 Email
* Reference 3 Relationship
Privacy Policy

I hereby acknowledge that I have received a copy of (or access to) KEEN's Privacy Policy (located here) and confirm that I have read and understand the terms of the Privacy Policy. As a KEEN Volunteer, I agree to abide by KEEN's Privacy Policy in its entirety, taking all reasonable measures to restrict the use and disclosure of Protected Information in accordance with the law and KEEN's Privacy Policy. As part of this overall commitment, I agree that:


• I will not share any information concerning any athlete's heath or medical information, including but not limited to information contained in the athlete profile, outside of a KEEN session or in any way unrelated to KEEN.

• I will return all athlete profiles to the session coordinator at the conclusion of each KEEN session.

• I will not contact a KEEN athlete at their home, school, place of work or any other setting outside of KEEN without the parent or guardian's express written permission.

• When discussing my participation in any KEEN program, I will be mindful of the need to protect the privacy and identity of KEEN athletes and their families.

* I agree to abide by the KEEN Privacy Policy and seek to serve as a KEEN Volunteer.
Consent and Release and Publicity Waiver
In consideration of the opportunity to participate in events or activities that are organized or coordinated by Kids Enjoy Exercise Now USA (“KEEN”) or one of its local affiliates, subsidiaries or agents (“Affiliates”), including sports and recreational activities (each, an “Event”):

1. I, the undersigned, and on behalf of myself and my and my Children's heirs, estates, insurers and assigns, agree that KEEN and its Affiliates shall not be responsible or liable for, and irrevocably release and discharge KEEN and its Affiliates, and their officers, directors, employees, agents and volunteers, from any claims or liability of any kind arising from any losses, damages or injuries (including death) to persons or property of any kind resulting, in whole or in part, directly or indirectly, from attendance at or participation in any Event, including without limitation, during travel or transportation to or from an Event whether by transportation provided by KEEN or its Affiliates or any other means.

2. I, the undersigned, do hereby consent, agree and give permission to KEEN and its Affiliates, and their officers, directors, employees, agents and volunteers, to take photographs and make, videotape, audiotape or digital recordings of the Participants, including myself, at the Event and to use, reproduce, exhibit, publish and otherwise exploit the Participants' likenesses, names, voices, statements, personal stories and biographies (collectively, “Likeness”), alone or with others, in any and all media, now or hereafter known, throughout the world in perpetuity for promotional, publicity, training and similar purposes. The Likeness may be altered or modified in KEEN's and/or its Affiliates' sole discretion. I waive any opportunity or right to inspect or approve any such use or exploitation of the Likeness. I agree that all materials created by or for KEEN and/or its Affiliates are the sole property of KEEN or its Affiliates (as relevant), including all copyrights therein. To the extent any Likeness may contain any matter subject to copyright protection in which I claims rights, I, hereby assign to KEEN and its Affiliates all right, title and interest, including copyright, in such matter in any and all media, now or hereafter known, throughout the world in perpetuity.

3. I, and on behalf of myself and my and my Children's heirs, estates, insurers and assigns, irrevocably release and discharge KEEN and its Affiliates, and their officers, directors, employees, agents and volunteers, from any claims or liability of any kind arising from the making, use, reproduction, publication, marketing or other exploitation of the Likeness, and any alteration or compilation thereof. I waive any rights, claims, or interest that I may have to control the use of the Likeness in any manner or in whatever media used. I understand that there will be no financial or other remuneration to the Participants for creating or exploiting the Likeness.

4. Regarding the releases granted herein, I expressly waive California Civil Code.

I agree to the Consent and Release and Publicity Waiver


I authorize KEEN to verify the accuracy of all statements herein and release KEEN from liability in connection with same. I understand that the above references will be contacted by a KEEN representative if I become a regular KEEN volunteer. I agree to abide by all relevant KEEN policies and regulations, including the “Volunteer Screening and Monitoring Procedures,” a copy of which has been provided to me. I also certify that I have never been convicted of a violent crime, child abuse or neglect, child pornography, child abduction, kidnapping, rape or any sexual offense, nor have I ever been ordered by a court to receive psychiatric or psychological treatment in connection therewith. By signing below, I authorize KEEN to photograph or film me at any KEEN activity for use in connection with KEEN promotional efforts.
* I have read and agree to this disclaimer.