*First Name:

*Last Name:

*Address:

Address 2:

*City:

*State:

* ZIP:

*Home Phone:

Cell Phone:

Preferred Method of Contact:

Employer:

Occupation:

Work Phone:

*Date of Birth:

*I am interested in serving as a Girls on the Run:

I prefer to work with Girls on the Run: (please check all available times and days)
Please Note: The VAST majority of our programs meet in the afternoon hours right after school. Our greatest coaching needs are in this timeframe.

Mon

Tues

Wed

Thur

Fri

Mornings (before 8:30AM)

Afternoon ( 2pm - 4pm )

Early Evening ( 4pm - 6pm )

Evening ( 6pm - 8pm )

Please select your top three areas of town in which you prefer to coach:

How did you hear about Girls on the Run?

What attracted you to the Program?

*Please list your previous experience working with children

Name one of your strengths and one of your challenges, especially in reference to
working with girls?

*As a coach, what is the one thing that you want the girls to specifically learn from you?

Why would you be a good role model to these girls?

Favorite sport / activity?

Favorite fruit?

Favorite dessert / treat?

Favorite thing to do on the weekends?

Please list two individuals who can serve as references for you and your character. Please provide full name, contact information, and relationship to you.

Coaching certification training is mandatory and will be held for new coaches interested in volunteering. Please check that you will be willing to attend a 1 day training session prior to the season.

*Yes, I will be willing to attend training.

Coaches must agree to undergo a criminal background check prior to coaching. Please check that you will be willing to undergo a criminal background check.

Please briefly list your education background.

Does your company support time off to volunteer? If yes, what Company?

Does your company have a Community Relations department? If yes, contact name and information?

Does your company have a company match program?

*As a Girls on the Run policy, coaches must be drug-free and tobacco-free and must not consume excessive amounts of alcohol. In addition, if a Girls on the Run coach has suffered from an eating disorder that coach must have completed treatment at least one year prior to the date signed below. By checking the "I agree" box, you solemnly swear that you are abiding by all of the above policies.
I agree.

*I solemnly swear that I have never been arrested for charges of child abuse, assault, child neglect, or sexual misconduct. I allow Girls on the Run to perform an online background screen through Volunteer Select.
I agree.