MAKE A DIFFERENCE
Basketball Volunteer Coach Application
Winter Season: Saturday, January 25-March 29, 2014
Do you enjoy sports and want to make a difference in your community? Coaching a youth
basketball team will allow you to share your skills with children who share your passion for
sports while you meet new people!
COACH INFORMATION:
• Volunteer coaches work with an instructor and coach a team of between 8-10 children.
• Coaches run 40-minute practices followed by a 40 minute game on ten (10) Saturdays
during the season. Practice and game time will depend on grade level of team.
• Dates are as follows: January 25**, February 1, 8, 15, 22, March 1, 8, 15, 22 and 29,
2014.
**January 25th practice will not have a game. Players will participate in drills and coaches
will complete player assessments. Rosters will be finalized at the end of the first
practice.
• Location: TBD
• Pre-season coach training will be Wednesday January 15, 2014 from 6:00-7:30 PM at
our Ypsilanti Y office at St. Luke’s Episcopal Church (120 N. Huron St. Ypsilanti, MI
48197).
HOW TO APPLY:
Please contact Colette Hemker for an application packet at 734-661-8031 or
[email protected] and return it by the Coach Training on Wednesday January 15,
2014.
Youth Sports, Page 1 ● 400 West Washington St., Ann Arbor, MI 48103 ● 734-996-9622 ● www.annarborymca.org
Ann Arbor YMCA Youth Sports Volunteer Application Form
Thank you for considering the YMCA as a place to donate your time and talents! Please complete all of
the information on this application and return it to Colette Hemker. Email [email protected],
fax (734) 661-8060 or return it to the Membership Desk, attn: Colette Hemker.
I. General Information
Today’s Date: _____/_____/__________
Birth Date: _____/_____/__________
Name: _________________________________________________________________________________________________ Sex: M / F
(Last)
(First)
(Middle)
Maiden names or names previously used: ____________________________________________
Are you 18 years of age or older?
Yes
No
If under 18, please state your age. ____
Address: ______________________________________________________ City: ________________________ State: ________ Zip: _______________
Phone: _______________________________ Email Address: ___________________________________________________________________________
Occupation: ___________________________________ Employer/School: _____________________________________________________________
Emergency Contact Name: ____________________________________________ Relationship: ______________________________
Phone number(s): _________________________/_____________________________
Have you ever volunteered or been employed at the Y?
Yes
No If yes, give dates: _____________________
List the names of any relatives or friends who are current or former employees of the Ann Arbor YMCA:
________________________________________________________________________________________________________
II. Interests
Please indicate if you are a YMCA member ______ non-member __________
What is your availability for coaching? (Please check all that apply) Combined practices/games take
place at Recreation Park. The day will consist of a 40-minute practice and a 40-minute game
consisting of four 8-minute quarters.
Youth Sports, Page 2 ● 400 West Washington St., Ann Arbor, MI 48103 ● 734-996-9622 ● www.annarborymca.org
BASKETBALL (TIMES SUBJECT TO CHANGE)
1-2 Grade – Saturday 9:30 – 10:30 AM
3-4 Grade – Saturday 10:30-12:00 PM
5-6 Grade – Saturday 12:00 – 1:30 PM
Why would you like to volunteer?
List any particular skills, talents, or interests you’d like to share.
What other organizations have you volunteered with, if any?
Youth Sports, Page 3 ● 400 West Washington St., Ann Arbor, MI 48103 ● 734-996-9622 ● www.annarborymca.org
Ann Arbor YMCA Volunteer Applicant Statement
In the Ann Arbor YMCA's efforts to attract the highest quality volunteer staff, I have been advised
that, as a part of the application process for volunteer service with the YMCA, an inquiry will be made
concerning my background, and I fully consent to and authorize all such inquiries.
If the Ann Arbor YMCA accepts my volunteer service, I will comply with all policies established
from time to time by the organization. I understand that inquiries may be made concerning my
background, experience, and prior employment. I hereby waive any right to claim that any request or
investigation is an invasion of my privacy, since it is made with my consent and it is in my interest that I
be considered for volunteer service.
I understand that my continued involvement as a volunteer is contingent upon a clean criminal
history background check. I understand that it is the YMCA's policy to secure criminal history information
as a part of the screening process for volunteers, including a Michigan criminal history report. I
understand that the Ann Arbor YMCA does not condone child abuse and that the Ann Arbor YMCA will be
seeking information in my background related to child abuse. I understand that the YMCA will take
seriously any allegations or suspicions of child abuse and will report such allegations to the police and
state agencies for investigation. I understand that for some volunteer assignments, health screenings are
required by law, and for such assignments my involvement as a volunteer will be contingent upon passing
the health screenings or otherwise meeting licensing standards.
I certify that all statements made by me on this application are true to the best of my knowledge
and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand
and agree that any misrepresentation or omission of facts would exclude my being considered for
volunteer service or, after my service begins, may be cause for termination.
I also understand that the YMCA strongly discourages any fraternization outside of YMCA
programs between volunteer staff members and youth participants. I understand that if a volunteer
wishes to fraternize due to a family relationship or longstanding friendship with a participant or the
participant's family, such fraternization must be disclosed to the volunteer's immediate supervisor.
Furthermore, it must not take place without the presence of another adult. All other personal contact
between volunteer staff members and youth participants is prohibited.
I understand and agree that if my service as a volunteer is accepted, there is no contract period
for volunteer service and my volunteer service would be solely "at will," giving either me or the YMCA the
right to terminate my volunteer service at any time without liability or obligation.
Volunteer Waiver: I understand that I am not an employee of the Ann Arbor YMCA. I agree that I will not
receive any compensation or benefit, nor will I be eligible for any coverage under Michigan Workers
Compensation Laws.
I hereby certify that I have never been convicted of a crime other than a minor traffic violation. I
authorize the Ann Arbor YMCA to utilize the above information for the sole purpose of obtaining a
criminal history file search and/or Children’s Protective Service evaluation.
I have never Been Convicted: _______ I have been convicted: _______ If “have been convicted”, please
explain:
I hereby acknowledge that I have read and understood the above statements and that I
voluntarily sign this application.
Signature of applicant
Date
_____________________________________________________________________________________________________________________________
Signature of parent/guardian (if applicant is under 18 years of age)
Date
Youth Sports, Page 4 ● 400 West Washington St., Ann Arbor, MI 48103 ● 734-996-9622 ● www.annarborymca.org
Ann Arbor YMCA
Volunteer Code of Conduct
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Smoking or use of tobacco products in the YMCA programs or on YMCA property is
prohibited.
Using, possessing, or being under the influence of alcohol or illegal drugs will not be
tolerated.
Any form of abuse of children will not be tolerated including:
Physical Abuse – striking, spanking, shaking, or slapping
Verbal Abuse- humiliating, degrading, or threatening
Sexual Abuse – including inappropriate touching and exposure
Mental Abuse (self esteem)- comparing or criticizing
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Volunteers shall treat everyone of all races, religions, and cultures with respect and
consideration.
Volunteers shall use positive techniques of guidance, including positive reinforcement and
encouragement rather than competition, comparison, or criticism.
Volunteers shall abstain from humiliating or frightening discipline techniques.
Volunteers shall not use profanity in the presence of children or adults.
Volunteers shall refrain from intimate displays of affection toward others in the presence
of children, adult members, and staff.
Monetary and/or expensive gifts to volunteers are prohibited.
Volunteers will do everything in their power to avoid being in a situation where they are
alone with a child (other than their own) at the YMCA or during a YMCA-sponsored
activity.
Volunteers will portray a positive role model for youth by maintaining an attitude of
respect, loyalty, patience, integrity, courtesy, tact and maturity.
I hereby acknowledge that I have read, understand and agree to abide by the Ann Arbor YMCA
Volunteer Code of Conduct.
Signature of applicant
Date
Signature of parent/guardian (if applicant is under 18 years of age)
Date
Youth Sports, Page 5 ● 400 West Washington St., Ann Arbor, MI 48103 ● 734-996-9622 ● www.annarborymca.org