ADULT PRE PARTICIPATION SCREENING AND REGISTRATION

I'd like to gain access to the following youth-serving organization:

Your Name (as on your state-issued ID) (copy) *

First

Middle

Last

In which sport/activity does this company compete? *

Company Name *

Company Address (include city and state) *

Company Phone Number *

Your Name and Contact Information

Headshot Upload (upload a minimum of 1, maximum of 3) *

Click or drag files to this area to upload. You can upload up to 3 files.

Upload headshot- (professional in nature)

Cell/Mobile Number *

please ensure this number is able to receive text messages

Email *

Date of Birth *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Previous experience in youth-serving activities- incomplete data will not be accepted *

format for each: Year Rostered, Company (ie: XYZ Gymnastics), Team Name, Coach Names, List Two References From Each Team

Do you have any current background screening clearances that grant participation in youth sports? *

YES
NO

Upload A Screenshot Of Your GreenLight Status

Click or drag a file to this area to upload.

max 10 MB

Your Emergency Contact

In the event of an emergency whom should we notify? This can not be anyone you currently reside.

Emergency Contact Name *

First

Last

Emergency Contact Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Phone *

Emergency Contact Relationship *

spouse, family friend, neighbor, etc.

Potential Participation with Juvenile Athletes

We provide screening services to adults requesting access to facilities that provide youth sports and recreational activities. All answered are used solely to ensure we are meeting local, state, federal and sport federation requirements.

Have you ever been charged with, convicted of, plead no contest, or guilty to any crime(s) involving or against animal, a child, or of a sexual nature? *

YES
NO

If yes, describe each in full:

If answered yes, continue this registration process and contact your Sports Compliance Company risk manager.

Have you ever been convicted of or plead no contest or guilty to any crime(s) in the last 7 years that would not satisfy the USOPC background screening requirement? The following criterion offenses are below in grey. *

YES
NO

Answering yes to this does not automatically disqualify you. Background Screening Criterion Offenses Any felony; and Any misdemeanor involving: All sexual crimes, criminal offenses of a sexual nature to include but not limited to; rape, child molestation, sexual battery, lewd conduct, possession and distribution of child pornography, possession and distribution of obscene material, prostitution, indecent exposure, public indecency, and any sex offender registrant; Any drug-related offenses; Harm to a minor, including, but not limited to, offenses such as child abandonment, child endangerment/neglect/abuse, contributing to the delinquency of a minor, and DUI with a minor; Violence against a person, force, or threat of force (including crimes involving deadly weapons and domestic violence); Stalking, harassment, blackmail, violation of a protection order, and/or threats; Destruction of property, including arson, vandalism, and criminal mischief; and Animal abuse, cruelty, or neglect. Criminal offenses include "Attempted Crimes" in the above classifications.

If yes, describe each in full:

Do you have any criminal charges pending against you regarding any crime(s)? *

YES
NO

Answering yes to this does not automatically disqualify you.

If yes, describe each in full:

Have you ever been refused participation in any other youth programs and/or listed on any youth-serving organization ineligible list? *

YES
NO

If yes, explain in detail.

Please list three references, at least one of which has knowledge of your participation as a participant/coach/volunteer in a youth program. Include their full name, address, cell phone, email address, and number of years known. *

FORMAT: Full Name, Address, City, State, Zip, Phone, Email, How Many Years Known?

The Sports Compliance Company will not discriminate against any person on the basis of race, creed, color, national origin, marital status, gender, sexual orientation or disability.

STATE OR FEDERALLY ISSUED IDENTIFICATION UPLOAD *

Click or drag files to this area to upload. You can upload up to 2 files.

upload two files- front and back of identification. Files must be under 10 MB.

As an adult requesting consideration to participate in a facility that primarily serves juvenile athletes, I acknowledge that I have read my sport governing body's rules, the rules and policies of the program I am requesting to participate with, and understand that there is to be zero one on one contact with any juvenile athlete at any time, both physically and electronically. If I am on a team with athletes who are minors I agree to not be in electronic conversations on any platform (Snapchat, Instagram, iMessage, etc) at any time.

I agree
I do not agree

IF YOU LIVE IN A STATE THAT REQUIRES A SEPARATE BACKGROUND CHECK BY LAW, PLEASE ATTACH A COPY OF THAT STATE’S BACKGROUND CHECK. FOR MORE INFORMATION ON STATE LAWS, VISIT OUR WEBSITE: Sportscompliance.com/StateLaws

AS A CONDITION OF CONSIDERATION FOR PARTICIPATING IN A FACILITY THAT PRIMARILY SERVES JUVENILES, I give permission for The Sports Compliance Company or their customer/youth-serving organization to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is conditional upon The Sports Compliance Company receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the The Sports Compliance Company, their affiliates, customers, contractors, the officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, The Sports Compliance Company is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension and removal for violation of The Sports Compliance Company policies or principles.

SIGNATURE- Type Name (as it appears on your ID) *

You acknowledge and agree that this application may be executed by electronic signature, which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature. Without limitation, “electronic signature” shall include faxed versions of an original signature or electronically scanned and transmitted versions (e.g., via pdf) of an original signature.

FOR RISK MANAGER USE ONLY

Background check completed by risk officer _________________________ on _________________ (insert date) System(s) used for background check (minimum of one must be checked): Review all background check requirements- JDP (Includes review of the US. Center of SafeSport’s Centralized Disciplinary Database and Sport Ineligible List)* National Criminal Database check National Sex Offender Registry U.S. Center of SafeSport’s Centralized Disciplinary Database and sport federation Ineligible List *Please be advised that if you use JDP and there is a name match in the few states where only name match searches can be performed you should notify volunteers that they will receive a letter or email directly from JDP in compliance with the Fair Credit Reporting Act containing information regarding all the criminal records associated with the name, which may not necessarily be the league volunteer. Only attach to this application copies of background check reports that reveal convictions of this application.