OLAV Volunteer Application

First Name

Middle Initial

Last Name

Address

Address 2

City

State/Province

ZIP

Primary Phone

Type

Secondary Phone

Type

Re-enter Email To Confirm

Have you ever been convicted of a felony?

Yes

(If yes, you may still be eligible to become a Presenter.)

A BACKGROUND CHECK IS REQUIRED WHEN AN OL VOLUNTEER APPLICANT INDICATES OR OLI IS OTHERWISE AWARE THAT AN APPLICANT HAS BEEN CONVICTED OF A FELONY.

Background checks:

Are conducted by OLI's General Counsel
Are kept confidential - only OLI's General Counsel will see the background check information
MUST be completed by the applicant

To have a background check conducted, complete the date of the felony and description of felony conviction fields below. If you have questions, please contact Sandy Pfau Englund, P.C. at spfau@nonprofitlaw.com

Date of Felony

I will be able to volunteer in the following state(s)

Work and Affiliations

Affiliation

Organization / School Type

Job Title

Are you retired?

Yes

Railroad Employer

Why do you want to become an Operation Lifesaver Authorized Volunteer?

How did you hear about Operation Lifesaver?

Do you enjoy speaking before groups?

Parent/Guardian Consent

Are you under the age of 18?

Yes

Parent Address 1

Parent Address 2

Parent City

Parent State

Parent Zip

Parent Phone

Parent Email

If you are under the age of 18, your parent or guardian must sign the consent form. PARENT/GUARDIAN CONSENT I understand that my minor child is applying to volunteer with Operation Lifesaver, etc. and/or an OL State Program. I hereby consent to my child’s participation and agree to be responsible for ensuring that an adult at least 18 years old accompanies or is present whenever my child volunteers with OLI or an OL State Program. I further agree to release, indemnify, and hold harmless OLI, the OL State Program with which my child volunteers, and their respective directors, officers, employees, successors, assigns, legal representatives, organizers, sponsors, and supervisors of its activities from any and all claims, causes of actions and liability arising from or in any way connected with my child’s volunteer participation with OLI and the OL State Program.

PARENT OR GUARDIAN SIGNATURE

PLEASE READ CAREFULLY BEFORE SIGNING

I understand and agree to abide by the policies of Operation Lifesaver, Inc. (OLI) and those of the state in which I wish to present, and to use only materials approved by OLI in my volunteer work, presentations, etc. I hereby affirm that the information provided by me on this application is complete and accurate. I understand that any falsification or omission will be grounds for immediate removal from my work with Operation Lifesaver (OL). Should OLI determine that an investigation of my background be advisable and warranted, I hereby authorize OLI to obtain data regarding information provided on this application and my background in general, including but not limited to any charges and/or convictions I may have had for violation of municipal, county, state or federal laws since reaching the age of majority (legal age). This information may be gathered from any source, including any law enforcement agency of this state or federal government, or from third-party providers of information originally obtained from law enforcement or court records. OLI reserves the right, in its sole discretion, not to certify an individual or to suspend or terminate any individual from participation as an OL Volunteer, Coach, Instructor, Presenter and/or from the OL program. Non-certification, suspension or termination may be made for any reason, including but not limited to violation of OLI policy, and/or any other reason based on the needs and best interests of OLI.

Applicant's Signature

Signature Date