General Information:

Name:     

Address:    

Phone Number:    (day)

(cell)

Email Address:    

Birth date:   Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec   Day: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 26 27 28 29 30 31   Year:

Are you over the age of 18:    Yes  No

Do you have your own transportation?:     Yes  No

Current school affiliation or organization membership:

Educational Background and degrees:

Current employer/position (please include contact information):

What experiences have you had that will contribute
to your work with S4AF?

What skills or talents would you like to share with S4AF?

What do you hope to gain from your experience?

Do you have any special certifications?

Have you ever been convicted of a crime? Yes  No

Please explain if yes.

When are you available?

Morning        Afternoon         Evening

Monday     Tuesday     Wednesday     Thursday     Friday

References:

List two references you have known for at least 1 year (at least 1 academic).

1. Name:   

Email:          

Phone:      

Relationship:

2. Name:   

Email:          

Phone:      

Relationship:

Mission Statement of Sports 4 All Foundation:

The mission of Sports 4 All Foundation is to improve the quality of life of those with disabilities by providing funding, equipment, programming, and education to enable full participation in sports and recreational activities. I have read the mission statement. I understand it and I desire to work with Sports 4 All to carry out the goals of the mission.

Signed:

Release Form

I. MEDICAL CONSENT (optional) Yes  No

In the event of a medical emergency, by signing this form, I confirm that I consent to the necessary and proper treatment, surgery and/or anesthetic by a licensed physician or health care professional for the individual named on this form

II. HEALTH CARE (optional) Yes  No

Volunteers are not covered by the Sports 4 All Foundation medical insurance plan. Please provide a person we can contact in case of an emergency.

Name:  Phone:
By signing this form I confirm that I understand that if I am injured during my assignment with Sports 4 All Foundation. I am responsible for all medical costs; Sports 4 All Foundation is not responsible.

III. PHOTOGRAPHY RELEASE (optional) Yes  No

By signing this form, I give Sports 4 All Foundation permission to take photograph and video of me and use such media in Sports 4 All Foundation's promotional materials and related publications without remuneration to me.

IV. RELEASE OF LIABILITY(mandatory)

By signing this form, I hereby assume full and sole responsibility for any and all risks of any physical or mental injury of any kind suffered by me associated with my voluntary participation with Sports 4 All Foundation (S4AF) and the activities. I hereby on behalf of myself and my respective agents, release, waive, forever discharge and/or covenant not to sue S4AF, its affiliates, and their directors, officers, employees, contractors, consultants and agents for any and all loss or damage and/or claims or demands of any type, known or unknown, on account of or in any way related to any illness, condition, and/or injury to my person or property, including my death, arising from or in connection with my participation with S4AF. I voluntarily release and will indemnify S4AF, their representatives, and employees from any and all loss, liability, damage or cost of any type related to my activities with this program, including any illness, condition and/or injury to my person or property and any liability arising out of the own negligence of S4AF.

V. Internship Agreement (mandatory)

By signing this form, I confirm that I agree that I will be operating as an intern for Sports 4 All. I do not expect any remuneration for my services. I understand that I may be reimbursed for some incidental expenses.

Signature: