2023 Adult Volunteer/Coach Application Form Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Occupation* Phone*Birthday*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Ethnicity*Caucasian or WhiteHispanic or LatinoBlack or African-AmericanNative American or American IndianAsian or Pacific IslanderOther or Prefer not to answerGender* Male Female Prefer Not to Answer Are you an alumni of First Tee?* Yes No If yes, please specify which chapter What interests you?* Programming Fundraising Administration Young Professional Special Events Please choose the program location where you are interested in volunteering*(select all that apply) Select All Elson Redmond Memorial Driving Range Tattersall Youth Development Center Belmont Golf Course Are you a member of the PGA or LPGA?* Yes No Are you certified in CPR?* Yes No Are you certified in First Aid?* Yes No Criminal History*Please list any felony or misdemeanor criminal convictions. Your listing should include DWI/DUI convictions, guilty pleas, etc. Note N/A if not applicable.Emergency Contact* First Last In case of emergency, please provide information below on whom we should contact.Phone*Authenticity & Medical Statements*I certify that I have given true, accurate and complete information on this form to the best of my knowledge. I understand that any false information or omission may be grounds for rejection of my application of corrective action or dismissal. I authorize previous employers, educational institutions, professional licensing boards and others to provide any information, including otherwise confidential or privileged information, requested by First Tee - Greater Richmond in its evaluation and verification of this application and of my credentials. I grant First Tee - Greater Richmond permission to give and/or seek emergency medical treatment, operation or anesthesia, which might become necessary for me, and I agree to be responsible for the expense of any such medical treatment or service. I have read and understand the Authenticity & Medical StatementsPolicy Statement for Disqualifying Offenses for Volunteer Services*In order to perform our due diligence in protecting the well-being and safety of each child we serve, First Tee - Greater Richmond (FTGR) will perform a criminal background check on all Volunteers. FTGR deems it necessary and advisable as a matter of policy to reserve the right to disqualify any person who has been charged with an convicted of any crime on FTGR's list of disqualifying offenses. The following offenses are grounds for disqualification, regardless of any extenuating circumstances: - Crimes against the family, sex related offenses, child related offenses, murder, felony theft/robbery/burglary offenses, and fraud related offenses and crimes against persons and property - All other offenses not otherwise described above may result in disqualification at the discretion of AISD and/or FTGR. Factors considered by FTGR to determine disqualification include the nature and severity of the criminal conduct, the length of time since the offense occurred, the likelihood of rehabilitation (which must be evidenced by community standing, employment and references) and other factors that FTGR may deem appropriate under the circumstances. I have read and understand the Risk Management PolicyChapter Policies & Procedures for Child SafetyFirst Tee - Greater Richmond does not allow volunteers to be alone with students at any time. Please ensure that there is another volunteer or staff member present whenever you are with a student. Ask for help from a member of the staff or volunteers. Volunteers may not accompany a child to the bathroom or to a secluded area under any circumstances. For the protection of the student and volunteer, the following actions are prohibited at all times: -spending time alone with a child -telling inappropriate jokes or stories -"making eyes at" or giving seductive looks -discussions of one's sex life or relationships -sitting too close or lying next to a child -finding ways to be alone with a child -confiding in a child about personal issues -engaging in physical "horseplay" such as tickling or wrestling with participantsProfessionalismPlease dress appropriately. Please keep cell phone use to a minimum while volunteering. Please do not smoke or use inappropriate language while volunteering.Student BehaviorFirst Tee - Greater Richmond has a Code of Conduct for participants. Each student should know and understand the Code. If a student causes a problem, please bring the situation to a staff member.First AidIn the event of injury or emergency involving a student, immediately call 911 if the injury is or could be severe or life threatening. Locate and contact the "Emergency Contact" person on file for the student. Render first aid until someone of higher medical training is capable to render further assistance. First Tee - Greater Richmond takes safety very seriously. We take important steps to ensure that we maintain the highest possible level of safety at our Chapter. One of those steps will be the successful completion of a comprehensive background screening process. You will receive the link to complete this process upon submittal of your Volunteer Application. Thank you for your interest in becoming a volunteer with First Tee - Greater Richmond!