Family CoordinatorApplication Form

Please ensure you read the duties and responsibilities for this role before completing this form.

If filling this form out electronically, where there is a box (☐)to select, please click on the box to select it.

Data Protection Statement
All information that we gather about you as an individual is held and processed by Special Olympics Great Britain strictly in accordance with the provisions of the Data Protection Act. It will be used to maintain our relationship with you and to provide you with information about our activities and for related purposes. We will not, without your consent, supply your name and address to any third party except where (1) such a transfer is a necessary part of the activities that we undertake with an international Special Olympics programme or an organisation endorsed by and authorised to act on behalf of Special Olympics GB, or (2) we are required to do so by the operation of the law. Your data will be stored and processed for as long as you are a member of Special Olympics GB.
As an individual, you have a right under the Data Protection Act to obtain information from us, including a description of the data that we hold on you.
Please contact Special Olympics Great Britain, Corinthian House, 6-8 Great Eastern Street, London EC2A 3NT or with any queries.
Event Details
Name of Event / 2019 World Summer Games
Date(s) of Event / 14 to 21 March 2019
Your Details
Full Name
(As written on your passport) / Name know by
Special Olympics Region
(If applicable) / Special Olympics Club
(If applicable)
Special Olympics GB Volunteer No. / DBS/PVG Date of Issue
Is the DBS/PVG at an enhanced level
(Please select) / ☐Yes ☐No / DBS/PVG Certificate No.
Which registered person/body is your DBS/PVG issued through?
Gender
(Please select) / ☐M ☐F / Date of Birth
Address
Postcode:
Phone Number(s) / Landline(s):
Mobile:
Email Address
Year joined Special Olympics?
National Competition Attendance (Please selectone of the following)
☐Not attended any national competitions
☐Attended 1 or 2 non Special Olympics national competitions as part of a participating team, or as part of the Event Organising Committee or as a family member
☐Attended 1 or 2 Special Olympics GB national competitions as part of a regional team, or as part of the Event Organising Committee or as a family member
☐Attended 3 or more non Special Olympics national competitions as part of a participating team, or as part of the Event Organising Committee or as a family member
☐Attended 3 or more Special Olympics GB national competitions as part of a regional team, or as part of the Event Organising Committee or as a family member
Please provide the details of the National Competitions you have attended including the roles held at each (both within and outside of Special Olympics)
International Competition Attendance (Please select one of the following)
☐Not attended any international competitions
☐Attended 1 or more non Special Olympics international competitions as part of a participating team, or as part of the Event Organising Committee or as a family member
☐Attended 1 or more Special Olympics International Invitational Competitions as part of a GB Team, or as part of the Games Organising Committee or as a family member
☐Attended 1 or more Special Olympics European Games as part of a GB Team, or as part of the Games Organising Committee or as a family member
☐Attended 1 or more Special Olympics World Games as part of a GB Team, or as part of the Games Organising Committee or as a family member
Please provide the details of the International Competitions you have attended including the roles held at each (both within and outside of Special Olympics)
Relevant Experience (please continue on a separate sheet if necessary)
Give details of your relevant experience and how this will help you meet all of the tasks detailed in the duties and responsibilities of this role.
(Please refer to the ‘Essential/Desirable’ criteria of the role before completing this section)
Personal Goals (please continue on a separate sheet if necessary)
What do you hope to achieve from attending this event? Do you hope to expand your role within Special Olympics GB in the future and if yes, in what capacity?
Relevant Qualifications (please continue on a separate sheet if necessary)
Name of Course / Qualification / Date achieved
Health/Medical Details (please continue on a separate sheet if necessary)
Do you have any current health/medical conditions? / ☐Yes* ☐No
*If yes, give details including how these are currently managed and what support you may require with them:
Applicant’s Declaration
I confirm that if selected, I am willing to act as aFamily Coordinator to the GB Team for the above event. I have received, read and understand the supplied Family Coordinator duties and responsibilities and agree to be bound by them.
If selected, I also agree to:
  • Follow instructions and guidance given to me by Special Olympics GB National Office
  • Immediately report to Special Olympics GB National Office any changes to my health, dietary requirements, medication which might affect my participation in the GB Team
  • Attend the following unless otherwise approved by Special Olympics GB National Office:
  • GB Team Training
  • Squad Training
  • Follow the current Special Olympics GB Volunteers Code of Conduct
  • Support any fundraising activities organised for the GB Team in general

Signature / Date
Referees
Please detail below two referees who can be contacted and will provide comment on your suitability if shortlisted for this role. They may be people either from within or outside of Special Olympics but it is preferred that:
  • It is someone who has known you for at least two years but is not a family member/partner
  • If you are or have been in employment in the last few years that one referee is someone who has known you in a capacity such as a current/ex employer or colleague

Referee1 / Referee 2
Name
Role
Email Address
Phone Number(s)

Thank you for taking the time to complete this form.

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