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SPECIAL OLYMPICS
 WESTMORELAND COUNTY
 CYCLING PROGRAM
 VOLUNTEER REGISTRATION FORM
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I am interested in becoming a volunteer with Special Olympics Westmoreland County Cycling Program.  I understand that I must agree to follow all established Coaches' Guidelines including wearing a helmet whenever riding. 
     
Training Sessions are held:    Tuesday 6:15 pm - 8:15 pm      Saturday 10:15 am - 12:15 pm
     
Volunteer Name:     _______________________________________  Age: _____ 
Street Address:   __________________________________________________
City, State, Zip Code:     ___________________________________________________
Day
Telephone #:____________________		 Evening Telephone#:____________________
Email Address: ____________________________
Please read before signing:  I understand that:
  • Upon request, I can be asked to submit an application for a criminal background check.
  • I will keep confidential any information I may receive during my volunteer activities.
  • Unless otherwise indicated by me, I grant Special Olympics permission to use my likeness,
    voice, and words in television, radio, film, or in any form to promote activities of Special Olympics.

I have read the above and the information I have given is true and complete.
Signed: ___________________________________ Date: ____________

Complete and Mail to:

 
Special Olympics-Westmoreland County
Cycling Program
PO Box 547
Greensburg, PA   15601