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Windermere Valley Minor Hockey Association

P.O. Box 2848, Invermere, B.C. V0A 1K0

Volunteer ApplicationForm

Association/Clubname:

Nameofvolunteer:

Address:

City:

Province:

Postal Code:

Phone(Residence):

Phone(Business):

Position(s)youare applyingfor:

Pleaseindicatebyprioritizingthepositioninwhichyouwouldliketo volunteer.

1.

2.

3.

4.

If yourchoicesarenotavailable, would youacceptadifferentposition?

YesNo

Identifyyour previousvolunteerposition(s) andteamcategory. (Attachpersonalresumeif necessary)

Year / Team/Association / Category / Position

TrainingExperience

CoachingProgram:YesNo

If yes,please complete below:

Level / Year Obtained / Location

NCCPCertificationNumber (CC#):

Initiation Program:YesNo

If yes,please completebelow:

Level / Year Obtained / Location

______

SafetyProgram:YesNo

If yes, please completebelow:

Level / Year Obtained / Location

______

Safety Program Qualification #:

Officiating Program:YesNo

If yes,please completebelow:

Level / Year Obtained / Location

Otherrelevanttraining

What are some ofyourpersonal future goals in the sportcommunity?

Whyare youvolunteering forthis position?

References:(Please listthree references i.e.parents,professionals).

Name: Address: City: Province: Postal Code: Phone (Residence): Phone (Business):

Name: Address: City: Province: Postal Code: Phone (Residence): Phone (Business):

Name: Address: City: Province: Postal Code: Phone (Residence): Phone (Business):

Screening

TheWindermere Valley Minor Hockeyiscommittedtoreducingharassment,abuseandbullyingin ourprograms.Asa prioritywearescreeningvolunteersandstafftoensurethehighestqualityofpersonneltosupportour programsandcreateafriendlyandwelcomingenvironmentforourparticipants.Somepositionsrequire additionalscreening.

Pleasebeadvisedthatyourpositionmayrequireacriminalrecordscheckanda vulnerablepersons check.

Doyouwishtodiscloseanypreviousrecord(s)of offences?

Notapplicable No Yes

OfficialChargeDateofConviction

Disclosureordiscoveryofapreviousrecordofoffencemaybeconsideredintheperson’sapplicationfor positionwithinthe “nameofassociation”.Basedonthecircumstancesoftherecord,a personmaybe excludedfrom participationwithinthe “nameofassociation”.

I herebyacknowledgethattheinformationprovidedaboveis accuratetothebestofmyknowledge.I

hereby consenttoamember of“name ofassociation”contacting thereferences listed above.

Signature______Date:

_

Personalinformationused,disclosed,securedorretainedby“nameofassociation”willbeheldsolely forthepurposesfor whichwecollecteditandinaccordancewiththeNationalPrivacyprinciples containedin thePersonalInformationProtectionandElectronicDocumentsActaswellas“nameof association”ownPrivacyPolicy.