Class A Volunteer Application - Special Olympics Iowa

Are you New or Renewing?*

New
Renewal

What is your desired role?*

Delegation Manager
Head Coach
Assistant Coach
Unified Partner (18+)
Volunteer
Chaperone

Name*

First Last

Place of Employment*

Delegation (Team) Name*

Date of Birth (MM/DD/YYYY)*

Gender*

Female
Male

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Consent*

By checking this box, volunteer acknowledges that they have read, or have had read to them, the Coaches Code of Conduct and that they agree to obey this Code of Conduct.

COACH CODE OF CONDUCT

Special Olympics Iowa adheres to the highest ideals of sport in the tradition of the Olympic movement. The Special Olympics Oath, “Let me win, but if I cannot win, let me be brave in the attempt,” represents the ideal of competition that every Special Olympics athlete tries to achieve.

I understand that my participation in Special Olympics as a coach is a call to excellence for me to teach in ways that bring honor to the athletes and to Special Olympics. I pledge to uphold the spirit of this Code of Conduct, which is only a general guide for my conduct and does not describe all types of good behavior and bad behavior. If I do not obey this Code of Conduct, my Delegation or a Games Organizing Committee may suspend me from Special Olympics, either temporarily or permanently. If I am suspended from Special Olympics, I can appeal the decision in accordance with the attached Special Olympics Appeal Process.

I Pledge that:
Sportsmanship
 I will practice and instruct the athletes to have good sportsmanship and act in ways that will bring
respect to the athletes, my team, Special Olympics and me.
 I will not use abusive language or behavior towards other persons. I will be a good role model and have a positive attitude.

Training and Competition
 I will conduct regular training sessions and meet training criteria set by Special Olympics Iowa. I will instruct the athletes to always try their best during training/practice and competitions.
 I will instruct the athletes to follow the rules of the sport, and I will encourage and support them, whatever their abilities.
 I will not allow the athletes to hold back in divisioning preliminaries in order to get into an easier
heat in the finals.

Personal Responsibility
 I will not make inappropriate or unwanted physical, verbal or sexual advances on others.
 I will not drink alcohol or use illegal drugs at Special Olympics events.
 I will not smoke in non-smoking areas.
 I will obey all laws and Special Olympics rules.
 I will always hold the athletes’ well-being and safety as my utmost responsibility.

If I violate this Code of Conduct and disagree with my disciplinary action, I agree to follow the Special Olympics Appeal Process and I will accept their decision as final.

Do you use illegal drugs?*

Yes
No

Have you ever been convicted of a criminal offense?*

Yes
No

Have you ever been charged with and/or convicted of neglect, abuse, or assault?*

Yes
No

Has your driver's license ever been suspended or revoked in any jurisdiction?*

Yes
No

If you answered "yes" to any of the above questions, please explain:

Consent*

Accept

I certify that the information provided is true and complete to the best of my knowledge. I understand that Special Olympics Iowa (SOIA) may refuse to allow me to volunteer if I provided any incorrect information or omission. I understand that in the course of volunteering for Special Olympics Iowa, I may be dealing with confidential information and I agree to keep said information in the strictest confidence. I WAIVE, RELEASE, AND DISCHARGE Special Olympics Iowa, its officers, directors, employees, volunteers, agents and representatives from any liability for all damages and losses of whatever kind or nature that may result in connection with participating in SOIA events. I understand that my volunteer service can be modified or terminated with or without notice or cause, at any time, at the option of SOIA or at my option and that SOIA may, in its sole discretion, decline to accept my application for volunteer with or without cause. I grant Special Olympics Iowa and Special Olympics, Inc. permission to use my likeness, voice, and words in or on telephone, radio, film, and on SOIA and Special Olympics, Inc.’s website(s), or in any other form, format, or media, to promote Special Olympics and its mission and to raise funds for Special Olympics. In submitting this application, I have read the foregoing information, and I agree to comply with the volunteer or coach code of conduct and all Special Olympics rules and regulations of the organization. By submitting this form, I grant Special Olympics Iowa permission to run a background check to complete application process. I HAVE READ AND UNDERSTAND THIS DISCLOSURE, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT.