Kauai Police Activities League 2023 VOLUNTEER REGISTRATION

Activity volunteering for

Position volunteering for

Practice

Town Volunteering for

Projected practice location

Birthday (MM/DD/YY) *

Drivers License # *

SSN if no driver's license (Type N/A if have Drivers license#) ) *

Shirt Size

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Work Information

Occupation

Employer

Work Address

Cell Phone

Work Phone

If you have a child participating

Name of Child

Division/level

Special professional training, skills or hobbies

Community affiliations (Clubs, Service Organizations, etc.)

Previous/current volunteer experience (ex. baseball/softball & year)

Any special certifications (ex. CPR, concussion, etc.)

Have you ever been convicted of a felony?

Yes

Have you ever been convicted of ANY crime involving or against a minor?

Yes

Have you ever plead guilty of or been convicted of ANY crime?

Yes

Have you ever been refused participation in any other youth programs?

Yes

If YES to any of the above, please explain?

Reference 1

Name

Contact number

Reference 2

Name

Contact number

Reference 3

Name

Contact number

Please visit www.cdc.gov/headsup to access a free online concussion training course and email certificate to kpal@kauai.gov . If unable to complete the online training, you will be REQUIRED to attend a provided training before being allowed to coach. If you have received concussion training through another entity within the past year, please email certificate, as it may be accepted as a substitute.

I agree and understand

As a condition of volunteering, I hereby grant permission to the Kaua’i Police Activities League (K-PAL) organization to conduct a background check on me, which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability K-PAL, it's Board Of Directors, the County of Kauai, the Kauai Police Department, the officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, K-PAL is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the Director or Commissioner and removal by the Board of Directors for any and all violations of K-PAL policies or principles.

I agree and understand

Sign here

First Name

Last Name

Choose how to sign

Draw Type

Signing indicates that you have read and agreed to all the waivers.

The Kaua’i Police Activities League will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability. Please contact kpal@kauai.gov or (808) 645-0080 if you have any questions. We will contact you regarding acceptance.