Internship Application

General Information:

Name:     

Address:    

Phone Number:     (day)

(cell)

Email Address:    

Birth date:     Day:   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 S4A?

What skills or talents would you like to share with S4A?

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

The mission of Sports 4 Alll is dedicated to turning disabilities into abilities through sports and healthy activities.

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 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. I am responsible for all medical costs; Sports 4 All is not responsible.


III. PHOTOGRAPHY RELEASE (optional) Yes   No

By signing this form, I give Sports 4 All permission to take photograph and video of me and use such media in Sports 4 All'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 and their activities. I hereby on behalf of myself and my respective agents, release, waive, forever discharge and/or covenant not to sue S4A, 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 S4A. I voluntarily release and will indemnify S4A, 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 S4A.

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:

 

 
 


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Sports 4 All
5827 Charlotte Pike | Nashville, Tennessee 37209
Phone: (615) 354-6454
Fax: (615) 356-5558

info@s4af.org

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