Sign up to be a Special Olympics Georgia volunteer

Please fill out the Volunteer Profile Form to be able to volunteer with Special Olympics Georgia. Completing this form DOES NOT sign you up to help with a State Games event... to volunteer at a State Games event, you must sign-up through the specific event's Registration Link on this same page. Click here: http://sogeorgia.vsyshost.com/ And select the event that you are interested in volunteering for. If the event you're interested is not listed, the registration may not be open for that event just yet. Any questions, contact Courtney Payne at 229-712-9973 courtney.payne@specialolympicsga.org or Nick Priolo at 770-414-9390 ext.1120 nick.priolo@specialolympicsga.org Thank you for volunteering with SOGA!

Volunteer Profile Form (NOT State Games Registration)

PLEASE FILL OUT FORM COMPLETELY. INCOMPLETE FORMS WILL NOT BE PROCESSED.
Questions, contact 229-712-9973
Application date
general volunteer
Check if you are a
coach
unified partner
driver
chaperone
GOC/committee member
local/area management team member
Other
Family/last name
First name
Middle name
DOB
Gender
County of Residence
Caucasian
African American
Hispanic/Latino
Asian
Other
Race (optional)
Home Address Line 1
Line 2
City
State
Zip/postal
E-mail
Home phone
Work phone
Mobile
Fax
If yes, Special Olympics Local Agency
Employer and Occupation
Are you already part of a Local Agency?
How did you hear about Special Olympics Georgia?
Please visit www.SpecialOlympics.org/ProtectiveBehaviors to complete the Protective Behaviors Training.
Please list the date the Protective Behaviors Training was completed:
1) Do you use illegal drugs?
2) Have you ever been convicted of a criminal offense?
3) Have you ever been criminally charged with neglect, abuse or assault?
4) Has your driver's license ever been suspended or revoked in any state?
5) Have you ever been adjudged liable for civil penalties or damages involving sexual or physical abuse?
If you answered yes to questions 1 - 5, please explain below; giving date, charge, state, etc.
*If you answered yes to questions 1 - 5, it does not automatically mean you will be ineligible to volunteer.
Please provide 2 non-family references:
Name
Relationship
Address or Phone Number
Name
Relationship
Address or Phone Number
In case of emergency, contact:
Relationship
Phone Number
Name
PLEASE READ COMPLETELY BEFORE SIGNING:
- By signing this form, I authorize Special Olympics Georgia and/or its agents to make an independent investigation of
my background, references, character, past employment, education, credit history, crimnal or police records,
including those maintained by both public and private organizations and all public records for the purpose of
confirming the information contained on my application and/or obtaining other inforamtio which may be material to
my qualifications for volunteerism now and, if applicable, during the tenure of my volunteer service with Special
Olympics.
- By signing this form, I release Special Olympics and/or its agents and any person or entity, which provides
information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the
information obtained from any and all of the above referenced sources used.
- In the course of volunteering for Special Olympics, I may be dealing with confidential information and I agree to
keep said information in the strictest confidence.
- The relationship between Special Olympics and volunteers is an "at will" arrangement, and taht it may be
terminated at any time without cause by either the volunteer or Special Olympics.
- I grant Special Olympics Georgia and Special Olympics, Inc. permission to use my likeness, voice and words in or
on television, radio, film and on Special Olympics Georgia's and Special Olympics, Inc's Website, or in any other
form, format or media to promote activities of Special Olympics.
- I understand that the Protective Behaviors Training must be completed every 3 years in order to be considered a
Class A volunteer.
By typing my name below, I agree to all terms listed above.
Your form will not be considered complete until ALL information is received by Special Olympics Georgia
The following is my true and complete legal name and all information is true and correct to the best of my knowledge
(this information may be used for screening purposes). Please print ALL information for your records.
Full Legal Name
Maiden Name or other names used
Date
- All information contained in this application is true and complete and correct to the best of my knowledge.
- I will contact the Special Olympics Georgia office at 770-414-9390 if any of my information changes.
- In electronically signing this application, I have read the forgoing information, and I agree to comply with the
volunteer or coach code of conduct and all Special Olympics rules and regulations of the organization.
I HAVE READ AND UNDERSTAND THIS DISCLOSURE AND AUTHORIZATION TO OBTAIN INFORMATION.
Volunteer Electronic Signature
Date
Electronic Signature of Parent or Guardian if Volunteer is a Minor (under 18)
Date
Print Full Name of Parent or Guardian