Name:
Address: City: State: Zip:
Home Phone: Work Phone: Cell Phone:
Email: Date of Birth (YYYY-MM-DD):
Occupation: Job Title:
Employer:
Employer Address:
Special training/skills/hobbies:
Community Affiliations (Clubs/service organizations, etc.):

Previous Volunteer Experience: Year(s)
Previous CAA Volunteer Experience: Year(s)
Will you have children in the JCB Program: Yes No
If yes, at what level:
Do you have a valid Driver's License?: Yes No DL Number:
Have you ever been convicted of any crimes? if yes, describe in full:

Have you ever been refused participation in any other youth program? if yes, explain:

In which of the following would you like to participate? (Check as many as apply)

League Official	Coach	Umpire	Field Maintenance
Manager	Scorekeeper	Concessions	Other

I give permission for the Julington Creek Baseball organization to conduct a background check on me which may include a review of criminal and child abuse records maintained by governmental agencies. I understand that if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the Creeks Athletic Association, Babe Ruth / Cal Ripken Baseball, Inc. the officers employees and volunteers thereof, or any other person or organization that may provide such information. If appointed I understand that, prior to the expiration of my term, I am subject to suspension by the league President and removal by its Board of Directors.

I agree.

Important! All volunteers and coaches must also complete the Background Check Form.