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SV North Athletic Association

Volunteer Clearance Form

SafeKids Program for Seneca Valley North Athletic Association

 The following constitute the policies of SVNAA with regard to awareness and prevention of abuse within our organization.

 •      SVNAA  is committed to provide a safe environment and to prevent child abuse and sexual misconduct.

 •      SVNAA will make every reasonable effort to ensure that every person involved in coaching/training a sport activity in our organization will abide by the SafeKids guidelines.

 •      SVNAA will make every reasonable effort to exclude any adult with a legally documented history of child abuse/molestation or any other conviction or record that would bring unnecessary risk to the health and safety of the participants of this organization. Therefore, every person applying for a position as a coach/trainer must complete an Employee Disclosure Statement (see form attached).

 •      SVNAA will take appropriate action on all allegations of child abuse and/or sexual misconduct. All allegations will be reported immediately to the authorities for investigation and will cooperate fully with any such investigation.

 The following represent the preventive measures of our organization with regard to abuse:

 •      Physical, mental, and verbal abuse of any of the participants, coaches, managers, employees, volunteers involved in our sponsored activities is not permitted.

•      Inappropriate touching of any kind is forbidden.

•      We agree to provide more than one adult working at or overseeing every activity. If a child needs special attention (one -on-one training or an individual meeting), it will be handled with the assistance or presence of another adult.

•      Coaches/trainers should not socialize with the participants outside of the sponsored activities of the organization.

•      Coaches/trainers should never ride alone with a child or participant in the car. Procedures will be established for coaches to follow in the event a participant is stranded at an activity.

•      Parents are encouraged to attend sponsored activities

 

By signing this statement, I acknowledge that we have adopted this program and have incorporated it into our program guidelines.

                                                                                                                                                                                    


Signature of Insured                                                   Title                                         Date


Employee/Volunteer Disclosure Statement for SVNAA

 
To be completed by each employee and volunteer who will have direct contact with youth participants

NAME:                                                                                                                                                       

Street Address:                                                                                                                                            

City:                                                                        

State:                      

ZIP:                                          


Social Security #:                                                                           Date of Birth:                                       

 

 1.      Background in Youth Sports (as Coach, Mgr., Official or other type): Add additional sheet if necessary.

Position Held                               League/Team Name                                          Date(s)                   City/State

 

 

 

 

 

 

 

2.  Previous Residence(s) for the last five years:

 

 

 

 

 

 

 

3.    Have you ever been convicted of a crime?  If yes, please explain.

 

 

 

 

 

 

 

By signing this application, I hereby verify that the information provided is true and correct. I further certify that I understand that the intent of SVNAA is to deny a position to anyone convicted of a crime of violence or a crime against another person. I understand and agree  that SVNAA its affiliates may, in their sole discretion, decline to accept my application for volunteer/staff services with or without cause.

 

 

 

 

                                                                                                                                                                                       

Signature                                             Printed Name                                                  Date

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