PARKS & RECREATION
BOROUGH OF LINDENWOLD
15 N. White Horse Pike
Lindenwold, New Jersey 08021
856-783-1848
Volunteer Youth Coach Application
Coach / Volunteer Information
Organization: __________________________
Date: _________________
FullLegalName____________________________________________________
DateofBirth:___________________Driver’sLicense#___________________
Previous(orMaiden)Name:___________________________________________
CurrentAddress:____________________________________________________
City,State,ZipCode:_________________________________________________
EmailAddress:______________________________________________________
HomePhone:()__________________CellPhone:()_________________
FirstAidTraining:Yes/No
CPRTraining:Yes/No
IwillComplywiththeBoroughofLindenwold’sOrdinance#1291Chapters:123‐1‐123‐5
(BackgroundChecks)
Icertifythattheaboveinformationiscorrect:
SignatureofApplicant:____________________________________________