This volunteer application and waivers are valid for a recurring volunteer opportunity, such as a Youth Sports coach, with the YMCA of Central Florida.

For the safety of all our volunteers, we ask that you please visit the YMCA of Central Florida website and review the information documented by the CDC to ensure you are making an informed decision around volunteering. We’ve also provided safety recommendations about how to keep yourself safe and how to help protect others. 

Thank you for volunteering with the Y as we work to make our neighbors stronger in spirit, mind, and body!

Personal Information

Please list your full, legal name as it would appear on your driver’s license or ID.











Employment History






Contact Information









Emergency Contact Information




Volunteering at the Y











Have you ever been convicted of an offense against the law, had adjudication withheld, prosecution deferred, or do you have any criminal charges pending? If yes, please provide a date, charge, and general comment.

A criminal record will not necessarily disqualify you. Factors such as age at time of offense, rehabilitation efforts, seriousness of crime, and the relationship between the offense and volunteer position will be taken into account.

I hereby acknowledge that I am seeking to volunteer for the YMCA of Central Florida. I understand this is an unpaid opportunity initiated by my own interest to help the YMCA further its mission and cause. I certify that all information provided throughout the duration of the volunteer application process has been true and accurate. Furthermore, I understand that this volunteer opportunity is for no greater than 12 months.

I agree to all of the standards stipulated in the attached Volunteer Handbook and understand that any violation of this or any YMCA policy may result in suspension and/or termination of my volunteer position. I also testify to reviewing and understanding the educational materials attached regarding child abuse prevention and reporting; and am aware that my “clearance” to participate as a volunteer is contingent upon the completion of additional Online training as well as a background check/screening appropriate for my volunteer role.

Please accept the signature below as my agreement to the conditions stated above and all policies and procedures set forth by the YMCA of Central Florida.



Conflict of Interest Policy


RATIONALE:
Amongst Board Members, Officers, Trustees, Volunteers, Employees and the YMCA of Central Florida (the Association) there exists a fiduciary relationship which carries with it a duty of loyalty and fidelity. Each Board Member, Officer, Trustee, Volunteer and Employee of the Association is responsible to administer its affairs honestly and economically, exercising the best possible care, skill and judgment for the benefit of the Association.

Each Board Member, Officer, Trustee, Volunteer and Employee of the Association is also responsible to make full disclosure of any interest which might result in a conflict on their part. 

The adoption of this Conflict of Interest Policy for the guidance of the Board Members, Officers, Trustees, Volunteers and Employees is to assure their awareness of and compliance with the aforementioned policy and that it is both timely and appropriate.

POLICY:
Each of the following should be considered and adhered to:
1. Board Members, Officers, Trustees, Volunteers, and Employees should exercise the utmost good faith in all transactions touching upon their duties to the Association and its property. In their dealings with and on behalf of the Association they are held to a rule of honest and fair dealing between themselves and the Association. They shall not use their positions, or knowledge gained there from, so that a conflict might arise between the Association’s interest and that of the individual or their family (defined as immediate family, parents and in-laws).

2. In any dealing which may affect the Association adversely, all acts of Board Members, Officers, Trustees, Volunteers and Employees shall be for the benefit of the Association.

3. No Board Member, Officer, Trustee, Volunteer or Employee shall accept, directly or indirectly, any favor which might influence or appear to influence their actions affecting the Association.

4. No Board Member, Officer, Trustee, Volunteer or Employee shall offer or solicit any gift, special payment, or favor to any governmental officer, agent or employee, or legislator, elected official, or court officer, directly or indirectly, for the purpose of obtaining any unlawful, or irregular services, judgments, legislative action, or favorable treatment from such governmental officer, agent or employee, legislator, court officer, or any agency represented by them.

5. Education and requests of public officials are part of Association members’ responsibilities and are not in conflict with them.

6. Board Members, Officers, Trustees, Volunteers and Employees shall avoid any activity, investment, other interest that involve obligations that are in conflict with the interest of the Association.

7. A full written disclosure by every Board Member, Officer, Trustee, Volunteer or Employee of all conflicts or potential conflicts not previously disclosed shall be made in writing to the members of the Board or Executive Committee of the Association as soon as practicable but before consummating the same.

8. It is recognized that situations may arise in which the Association may wish to contract or enter into an arrangement for goods or services with individual Board
Members, Trustees, or Volunteers, or with firms or corporations of which a Board Member, Trustee, or Volunteer may be a member, Officer, or Employee. In this event before entering into any such contract or arrangement: (i) the terms of the contract or arrangement shall be disclosed to the Executive Committee, (ii) the Executive Committee shall determine that such contract or arrangement is upon terms and conditions as advantageous to the Association as can be obtained from any other source in an “arms length” transaction; and (iii) the Executive Committee (with the subject Board Member abstaining) shall by resolution approve such contract or arrangement. 

9. Annually, the President shall send to all Board Members, Officers, Trustees, and selected Volunteers and Employees a copy of this Resolution, together with an explanation and a confidential disclosure questionnaire which shall be completed and returned. The President shall submit a confidential report to the Executive Committee concerning any interests of Board Members, Officers, Trustees, or Employees together with his/her actions concerning the same. The President will administer this policy and any disputed action of the President with respect to conflict of interest matters shall be resolved by the Executive Committee. 

10. Each new Board Member, Officer, Trustee, and selected Volunteers and Employees shall participate in a similar procedure upon assumption of his/her responsibilities.

Conflict of Interest Policy: Explanation and Questionnaire

As a public charity and institution, the YMCA of Central Florida (the Association) must be constantly vigilant to maintain the public’s trust. As such, the Officers, Board Members, Trustees, Volunteers and Employees of the Association must act within their duties of loyalty and fidelity in a manner that is honest, forthright, and above reproach. This policy is intended to (a) define clearly potential conflicts of interest, (b) require disclosure of potential conflicting interests, and (c) require Board Members, Officers, Trustees, selected Volunteers, and selected Employees to review the policy and annually disclose any potential conflicts of which the Board should be made aware.

DEFINITION:
A conflict of interest may exist in those instances where the actions or activities of an individual on behalf of the Association also involve (a) the obtaining of a personal gain or
advantage; (b) an adverse effect on the Association’s interests; or (c) the obtaining by a third party of an improper gain or advantage. Conflicts of interest can arise in other instances. While it is impossible to list every circumstance giving rise to a possible conflict of interest, the following will serve as a guideline of the types of activities which might cause conflicts and which should be fully reported to the Association.
1. Interests
a. Holding by a Board Member, Officer, Trustee, Volunteer or Employee (including members of their families) directly or indirectly, of a position or of a material financial interest in any outside concern (i) from which the Association secures goods or services, or (ii) which provides services similar to those provided by the Association with the same constituency pool. 

b. Competition with the Association by an individual, directly or indirectly, in the purchase or sale of property or property rights or interests.

2. Outside Activities 
a. Providing services to any outside concern which does business with, or whose activities are adverse to the Association and its Mission. 

b. Participation, by an Association employee, in any activity (whether for personal profit or incident to industry, civic, or charitable organization affairs) if it is likely to involve continued and unreasonable use of the individual’s time during normal business hours. 

c. Campaigning for an elected political office while on duty or while representing the Association, endorsing a candidate for political office on behalf of the Association, or otherwise assisting a candidate in the campaign for office by using the Association’s resources or reputation.

3. Gifts, Gratuities and Entertainment 
a. Acceptance by an individual of gifts, excessive or unusual entertainment, or other favors out of the ordinary course of business from any outside concern which does, or is seeking to do business with, or is a competitor of, the Association under circumstances from which it might be reasonably inferred that such action was intended to influence the individual in the performance of their duties. This does not include the acceptance of items of more than nominal value which are of such a nature as to indicate that they are merely tokens of respect or friendship and not related to any particular transaction or Association activity. 

b. The giving by an individual of gifts, special payments, excessive or unusual entertainment, or other favors to any governmental employee, legislator, elected official, or court officer, directly or indirectly, for the purpose of obtaining any unlawful, special or irregular services, judgments, legislative action, or favorable treatment from such governmental employee, legislator, elected official, court officer, or any agency represented by them. This does not include the gift of items of more than nominal value which are of such a nature as to indicate that they are merely tokens of respect or friendship and not related to any particular transaction or Association activity.

4. Inside Information 
a. Disclosure or use of Association information for the personal profit or advantage of the individual or anyone else. 

DISCLOSURE OF POTENTIAL CONFLICTS:
You should make full disclosure of any situation in doubt so as to permit an impartial and objective determination. Disclosure should be made in writing to the Executive Committee as soon as knowledge of the potential conflict arises. Include in such disclosure the significant facts and circumstances of the potential conflict and any other information which could assist the Association in making a determination. Please note, this disclosure relates not only to yourself, but also to your immediate family.

BOARD MEMBER PROTOCOL:
Any member of the Association’s Board who has a potential conflict of interest in a specific action of the Board under consideration at a meeting is expected to excuse themselves from any influence on such action, request the minutes of the meeting note their abstention and, where appropriate, leave the room during discussion of the action. Since every situation and circumstance cannot be anticipated or disclosed in advance, the Association relies upon the honesty and integrity of each individual to comply with this protocol.

ANNUAL REVIEW AND DISCLOSURE: 
The Association will require all Board Members, Officers, Trustees, Volunteers and Employees to annually review and adhere to this policy. Only members of the Corporate Board, selected Volunteers, and selected Employees will be required to annually complete and sign a confidential Disclosure Questionnaire and return it to the President’s Office. “Selected Employees’ is hereby interpreted to mean the Association’s Management Team as defined by the President. “Selected Volunteers” is hereby interpreted to mean members of Committees of the Association Board as identified by the President. The President will annually make a report to the Executive Committee based on the disclosure forms submitted.

Conflict of Interest Policy: Annual Confidential Disclosure Questionnaire

I have read the Association’s Conflict of Interest Policy and as a result I wish to report the following:
Material Financial Interest

If none, state None.
Profit/Gain from Association

If none, state None.
Professional Connection

If none, state None.
Receiving Gifts, Payments, Favors

If none, state None.
Giving Gifts, Payments, Favors

If none, state None.
Potential Conflict of Interest

If none, state None.


Waiver, Release, and Indemnification Agreement

Effective May 2020

In consideration of being permitted to utilize facilities, services, and programs of the YMCA of Central Florida for any purpose, including but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the YMCA of Central Florida, without respect to location, the undersigned for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA of Central Florida for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated programs have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation. 

 

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA OF CENTRAL FLORIDA AND TO UTILIZE ANY OF ITS FACILITIES OR PROGRAMS FOR ANY PURPOSE, INCLUDING BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES AND EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE YMCA OF CENTRAL FLORIDA, WITHOUT RESPECT OT LOCATION, THE UNDERSIGNED

HEREBY AGREES TO THE FOLLOWING:

1.    THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA of Central Florida, its directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his or her personal representatives, assigns, heirs, and next of kin for any loss or damage, sickness or illness, specifically including, but not limited to any damage whatsoever to undersigned in any way related to bacteria, viruses or other pathogens associated with a local outbreak, pandemic, or unknown; and  any claims or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or while participating in YMCA services or programs without respect to location including travel.

 

2.    THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or about the YMCA of Central Florida premises or in any way using any facilities or equipment of the YMCA of Central Florida or participating in Y services or programs without respect to location including travel whether caused by the negligence of the releasees or otherwise.

 

3.    THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, ILLNESS, SICKNESS, DEATH, OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while in, about, or upon the premises of the YMCA of Central Florida and/or while using the premises or any facilities or equipment affiliated with the YMCA of Central Florida without respect to location including travel.

 

4.    THE UNDERSIGNED HEREBY AGREES TO WAIVE ANY LIABILITY arising out of any actual, alleged, or threatened infectious, pathogenic, toxic, or other harmful properties of any “organic pathogen”, which includes but may not be limited to bacteria, viruses or other pathogens whether or not a microorganism, regardless of whether such “organic pathogen” is the result of a local outbreak, pandemic, or unknown.

THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the state of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. 




Photo/Audiovisual/Narrative Release

Effective April 2018
Consent
For participation in activities to be conducted by the YMCA of Central Florida, consent must be provided, now and indefinitely, to the YMCA of Central Florida and collaborating third parties to make, reproduce, edit, broadcast, or rebroadcast:
  • video film or footage of me (or my dependent child)
  • soundtrack recordings of me (or my dependent child)
  • photo reproductions of me (or my dependent child)
  • any narrative account of my (or my dependent child’s) experience
Consent gives permission to use the above materials for publication, display, sale or exhibition in promotions, advertising, education, and legitimate business use. Use includes unlimited and unrestricted reproductions in any form and media, adaptations, and/or revisions created for YMCA of Central Florida use.

I understand and agree there may be no compensation for this, and I will not make any claim for payment of any kind. I may or may not be identified in such reproductions; however, my name will not be used to endorse any particular commercial products or commercial services. 
Ownership, Confidentiality, and Shared Use
With respect to any of the above uses, I further agree:
  • All uses shall belong to the YMCA of Central Florida and it may share them with others.
  • There is no obligation of confidentiality.
  • YMCA of Central Florida and collaborating third parties will not be liable for any use or disclosure to a third party.
  • YMCA of Central Florida shall exclusively own all known or later existing rights to the uses worldwide.
  • YMCA of Central Florida can use any video film, footage, soundtrack recordings, and photo reproductions of me and/or my narrative account for any purpose and without compensation to me.
Release from Liability
I agree that my consent is irrevocable. I hereby release and discharge the YMCA of Central Florida, its related parties, and those it has given permission to use the above, from any and all claims, actions, lawsuits, or demands of any kind arising out of my consent, the use of the shared use of the above materials.






Photo/Audiovisual/Narrative Release Opt-out: General Release from Liability
My signature serves as an indication that I have declined to sign the YMCA of Central Florida’s Photo/Audiovisual/Narrative Release.

I am fully aware that the YMCA of Central Florida’s Code of Conduct contained provisions that prohibit all members, guests, and other individuals not in the direct employment of the YMCA of Central Florida or representing the interests of the YMCA of Central Florida from taking photographs or videos on the premises or inside the facilities of the YMCA of Central Florida at any time. Accordingly, I acknowledge that the YMCA of Central Florida cannot be responsible if an individual not in the direct employment of the YMCA of Central Florida or representing the interests of the YMCA of Central Florida captures my likeness in any way, shape, or form and I agree to release the YMCA of Central Florida capturing my likeness, including but in no way limited to, photos, videos, or audio recordings.

Furthermore, my signature below serves as my acknowledgment that, when the YMCA of Central Florida is taking official photos, videos, or audio recordings, the YMCA of Central Florida will be responsible for posting signage to that effect. By declining to sign the Photo/Audiovisual/Narrative Release, I agree to remove myself from any areas in which the YMCA of Central Florida is taking official photos, videos, or audio recordings and release the YMCA of Central Florida from any liability if I refuse to vacate said area. 




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Notice of Privacy Policy