Last Name: Legal First Name: Nickname: Middle Name:
Previous Last Names:(list all) 
Street Address: County:
City: State: Zip Code:
Date of Birth:  (Use this format mmddyyyy) Social Security#:  (Required for background check. Kept confidential.)
email: Gender:MaleFemale
Home Phone: Work Phone: Cell Phone:
Employer Name: Occupation:
Street Address:
City: State: Zip Code:
In the event of an emergency, please contact
Name: (First and Last)  Relationship: Phone:
1. Do you use illegal drugs? Yes No
2. Have you ever been convicted of a criminal offense? Yes Date:  (Use this format mmddyyyy) No
3. Have you ever been charged with neglect, abuse or assault? Yes Date: (Use this format mmddyyyy) No
4. Has your driver's license ever been suspended or revoked in any state? Yes Date: (Use this format mmddyyyy) No
If you answered "Yes" to any of the above questions, You must complete the explanation field below.
List two non-family references
Name: Relationship: Phone:
Name: Relationship: Phone:
Volunteer Opportunities  Please check the categories you are interested in:
SPORTS TRAINING (Coach, Chaperone, Unified Partner)
Work directly with athletes to improve their skills; requires a commitment to weekly practices for 10-12 weeks and to attend competitions (overnight stay may be required):
Please check sport(s) of interest:
Alpine Skiing Aquatics Athletics (Track and Field) Basketball Bocce Bowling Cross Country Skiing Golf Gymnastics Long Distance Running Powerlifting Snowboarding Snowshoeing Soccer Softball Volleyball
LOCAL PROGRAM COMMITEE INVOLVEMENT- Commit to meetings as needed (minimum of 1 per month):
The Local Volunteer Committee is responsible for the operations of it's local Special Olympics sports program. This committee raises the funds to finance the program, approves expenses, secures practice venues, recruits volunteer coaches and makes all decisions affecting their local program.

Examples of possible sub-committees: fundraising, sports management, athlete database management, volunteer database management, public relations and finances
I am interested in helping at State Fundraising Events (The Bite, Trail Blazers Street Jam, etc.)
I am interested in helping at the State Competition Events (Winter, Summer or Fall Games)
Please Read Carefully and Sign Below
I understand that I will not be approved as a Class A volunteer until:
  • I have passed a criminal background check.
  • I have completed Special Olympics Oregon, Inc. General Orientation training and quiz.
  • I have completed Special Olympics Oregon, Inc. Protective Behaviors training and quiz.
If approved as a Class A volunteer I agree to the following:
  • I grant Special Olympics Oregon permission to send me correspondence and notifications.
  • I will abide by the rules and policies of Special Olympics Oregon.
  • I will exhibit good sportsmanship and be a positive role model.
  • I will refrain from and prohibit physical and verbal abuse, profanity and other inappropriate behavior.
  • I will refrain from and prohibit the use of alcohol, illegal drugs, pornographic materials and controlled substances while acting in a volunteer capacity for Special Olympics Oregon. (Tobacco in restricted areas)
  • I will guarantee adequate supervision of athletes at all times to assure their safety.
  • I will refrain from engaging in a romantic or sexual relationship with any athlete registered or participating with Special Olympics Oregon.
I understand that:
  • The information I have provided may be verified, and I give my permission to Special Olympics Oregon, Inc. to make inquiry of others concerning my suitability to act as a Special Olympics Oregon volunteer.
  • In the course of volunteering for Special Olympics Oregon, 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 it may be terminated at any time without cause by either the volunteer or Special Olympics.
  • I grant Special Olympics permission to use my likeness, voice and words in television, radio, film or any form to promote activities of Special Olympics.
By checking this, I affirm that I have read and agree to the above and that the information I have given is true and complete.
Signed _________________________________________ Date:  (Use this format mmddyyyy)
If you are under 18 years old, your parent/guardian must give permission for you to volunteer. Please complete the items below.
Parent Name: Email: Phone: