Vendor Application Please enable JavaScript in your browser to complete this form. - Step 1 of 5The following questions pertain to the youth-serving organization you wish to provide services.In which sport/activity does this company compete?CheerleadingAlpine SkiingAmerican FootballArcheryArtistic SwimmingBadmintonBaseballBasketballBeach VolleyballBiathlonBowlingBoxingBull RidingCanoeingClimbingCricketCross Country SkiingCrossfitCurlingCyclingDanceDiscusDivingDodgeballEquestrianEsports (Electronic Gaming)FencingField HockeyFigure SkatingFlag FootballGolfGymnasticsIce HockeyIce SkatingJudoKarateKickballLacrosseMixed Martial Arts (MMA)Motorcycle RacingMountain BikingNASCAROTHER - NOT LISTEDPickleballPokerPole VaultPolo (Horses)PowerliftingRacquetballRhythmic GymnasticsRowingRugbySailingScuba DivingShootingVolleyballSkateboardingSki JumpingSkiingSnowboardingSoccerSoftballSpeed SkatingSprintingSurfingSwimmingTable TennisTaekwondoTennisTrack & FieldTrack CyclingTrampolineTriathalonTriple JumpVolleyballWater PoloWeightliftingWinter Sports- Other/not listedWrestlingCompany Name *Company Address (include city and state) *Company Phone Number *NextName and Contact InformationHeadshot 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)Your Name (as on your state-issued ID) *FirstMiddleLastCurrent Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Cell/Mobile Number *please ensure this number is able to receive text messagesDate of Birth *Background Screening in Amateur Sport- Do you have a current Green Light determination? *YESNOUpload A Screenshot Of Your GreenLight Status Click or drag a file to this area to upload. max 10 MBNextYour Emergency ContactIn the event of an emergency whom should we notify?Emergency Contact Name *FirstLastEmergency Contact Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmergency Contact Phone *Emergency Contact Relationship *spouse, family friend, neighbor, etc.NextPotential Participation with Juvenile AthletesHave you ever been charged with, convicted of, plead no contest, or guilty to any crime(s) involving or against a minor, or of a sexual nature? *YESNOIf yes, describe each in full:(If volunteer answered yes to this, the local youth-serving organization must contact your Sports Compliance Company Risk Manager.)Have you ever been convicted of or plead no contest or guilty to any crime(s)? *YESNO(Answering yes to this, does not automatically disqualify you as an athlete.)If yes, describe each in full: Do you have any criminal charges pending against you regarding any crime(s)? *YESNO(Answering yes to this, does not automatically disqualify you as a athlete.)If yes, describe each in full: Have you ever been refused participation in any other youth programs and/or listed on any youth organization ineligible list? *YESNO(If volunteer answered yes to this, the local youth-serving organization must contact your Sports Compliance Company Risk Manager.)If yes, explain in detail.Please list three references, at least one of which has knowledge of your participation as an athlete 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? 1. 2. 3.NextThe 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 access 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 ever provided athlete contact information who are minors I agree to not be in electronic conversations on any platform (Snapchat, Instagram, iMessage, etc) at any time. I agreeI do not agreeIF 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/StateLawsAS 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 ONLYBackground 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.CheckboxesFirst ChoiceSecond ChoiceThird ChoiceSubmit
