Rev
10
/2018
◊◊◊ LITTLE LEAGUE BASEBALL CANADA VOLUNTEER APPLICATION FOR 2021 ◊◊◊
Do not use forms from past years. Use extra paper to complete if additional space is required.
A COPY OF VALID GOVERNMENT ISSUED PHOTO IDENTIFICATION MUST BE
ATTACHED TO COMPLETE THIS APPLICATION.
Name __________________________________________ Date _______________
Address_____________________________________________________________
City____________________________ Prov. ___________ Postal code_________
Phone: Home ________________Cell _______________ Business _____________
E-mail address_______________________________________________________
Date of Birth ________________________________________________________
Occupation _________________________________________________________
Employer___________________________________________________________
Address_____________________________________________________________
Special professional training, skills, hobbies: _______________________________
___________________________________________________________________
Community affiliations (clubs, service organisations, etc.):
___________________________________________________________________
Previous volunteer experience (including baseball/softball) and year:
___________________________________________________________________
1. Do you have children in the program? Yes No If yes, list full name and
what level________________________________________________________
2. Special Certification (i.e. CPR, Medical etc.): Yes No
3. Do you have a valid driver’s license: Yes No
Driver’s license #: _____________________________________Prov.________
4. Have you ever been convicted of or plead guilty to any crime(s) involving or
against a minor?: Yes No
If yes, describe each in full: ___________________________________
5. Have you ever been convicted of or plead guilty to any crime(s)? Yes No
If yes, describe each in full: ___________________________________
(Answering yes to question 5, does not automatically disqualify you as a voulunteer.)
6. Do you have any criminal charges pending against you regarding any
crime(s)?: Yes No
If yes, describe each in full: _________________________________________
7. Have you ever been refused participation in any other youth sports program?
Yes No If yes, explain:
___________________________________________________________________
In which of the following would you like to participate? (Check one or more.)
League Official Coach Umpire Field Maintenance Manager
Scorekeeper Concession Stand Other
Please list three references, at least one of which has knowledge of your participation
as a volunteer in a youth program. Do not use a family member as a reference.
Indicate if the reference is aware that you are using him/her as a reference:
Name/Phone/Email
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Little League Baseball Canada has implemented a screening program for all Little
League volunteers. As a condition of volunteering, I give permission for the Little
League organization to conduct background check(s) on me now and as long as I
continue to be active with the organization, which may include a review of sex offender
registries (some of which contain name only searches which may result in a report being
generated that may or may not be me), child abuse, and criminal history records. 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 local Little League, Little League Baseball Canada, Little
League Baseball Incorporated, the officers, employees, and volunteers thereof, or any
other person or organization that may provide such information. I also understand that,
regardless of previous appointments, Little League 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 Little League policies or principles.
Applicant Signature ________________________________ Date _____________
If Minor/Parent Signature ___________________________ Date _____________
Applicant Name (please print or type) ___________________________________
NOTE: The local Little League
, Little League
Baseball Canada, and Little League
Baseball Incorporated will not discriminate against any person on the basis of race,
creed, colour, national origin, marital status, gender, sexual orientation, or disability.
Local League Use Only:
Background check completed by league officer __________________________
On ______________________________________________________________
Attach copy of background check reports that reveal convictions of this
applicant.
“Help Keep Our Little Leaguers Safe”
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