Name

Home Address

Home Phone

Cell Phone    

Work Address

Work Phone 

Fax               

Driver’s License # /State/ Expiration Date

Preferred E-mail Address

II. AVAILABILITY (Please check all that apply.)

Day of week: M Tu W Th F Sa Su
Time of Day: 9-12 12-5 5-9

III. AREAS OF INTEREST (Please check all that apply.)

I would like to work with youth who are:
Beginners Intermediate Advanced Registration No preference

Activities:
Registration  Photography  Snacks Mentoring Rules/etiquette Other

Administrative Activities

Clerical: create brochures, flyers, etc. Media relations
Database development (mailing list, etc.) Fund raising
Web site development Other

IV. REFERENCES

As a youth-oriented organization, Langston Junior Boys & Girls Golf Club requires all volunteers who will be working with our junior members to provide a list of at least three (3) references. Please use a separate sheet to list the names, phone numbers, and relationships of the persons you are granting us permission to call on your behalf.

Reference #1
Name              
Phone Number
Relationship    

Reference #2
Name              
Phone Number
Relationship    

Reference #3
Name              
Phone Number
Relationship    

V. CONSENT

I, , an applicant for a volunteer position with Langston Junior Boys & Girls Golf Club, hereby attest that I have never been found guilty of, or entered a plea of nolo contendre (no contest) or entered a plea of guilty to a crime determined to be a misdemeanor or felony, including abuse of or neglect against a child, or assault, theft, arson, or possession of any drug.

I understand that I may be subject to a criminal background check.

OR

My record may contain one or more of the foregoing acts or offenses.

Date