Volunteer/Coach Registration Form "*" indicates required fields Personal InformationName* First Last Date of Birth* Month Day Year Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Do you have a valid Drivers License?* Yes No Emergency Contact InformationName* First Last Relationship* Phone*Program InformationIdentify which program you volunteer for:* Para-Cycling Adult FItness Para-Fit Curling Aqua-Abilities PEI Ice Breakers Sledge Hockey Program Wheelchair Basketball Wheelchair Rugby Boccia Please list your previous volunteer experience.*Please list any related skills, training, certifications, etc*Please upload a copy of certifications/qualifications listed Drop files here or Select files Max. file size: 256 MB. Do you have a valid Vulnerable Sector Check within 12 months?* No Yes, but I haven't submitted it yet I have already sent a copy to ParaSport PEI A copy of Vulnerable Sector Check*Accepted file types: jpg, png, pdf, Max. file size: 256 MB.Contact us if you need a Reference Letter Please have your Vulnerable Sector Check completed within 7 days and: Email: [email protected] Phone: 902-368-4540 Fax: 902-368-4548 Photo Release Consent*ParaSport and Recreation PEI may take photographs or videos of participant to publish on ParaSport and Recreation PEI’s website, newsletters, newspapers, or social media. By ACCEPTING these terms and conditions in its entirety, you give permission for you/your child to be included in these photographs/videos and agree that you have read and understand the policy. I authorize ParaSport and Recreation PEI to take and use any photos and/or videos taken of me/my child during their programs or events. Yes, I allow my picture to be taken No, I do not allow my picture to be taken Terms and Conditions* I have read and agree to terms listed in the Waiver for participants over 18 years old I have read and agree to terms listed in the Waiver for participants under 18 years old Applicant's Signature (Over 18)* Reset signature Signature locked. Reset to sign again Parent or Guardian Signature (U18)* Reset signature Signature locked. Reset to sign again Date Signed* Month Day Year Δ
