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GOTR Coach Application 2014Please print clearly and return this application by December 20th to:

Girls on the Run of SoutheastAlaska , SAFVP.O. Box 6136 Sitka, AK 99835

[email protected]

THANK YOU for your interest in coaching Girls on the Run! *Girls on the Run is a self-esteem and healthy lifestyle empowerment program for 3rd-5th graders, celebrating our sixth season in Sitka. We look forward to working with you and will contact you for an interview when we receive your application! Please contact Elena at 747-3370 with any questions.*The 2014 season runs from the week of February 10th-May 5th, with the final 5K on May 11th. All Head and Assistant Coaches are required to attend a free training in Sitka on January 25th for orientation to the program and to connect as a coaching team. Running Buddies are welcome to attend.

LAST NAME: FIRST NAME: M.I:

HOME ADDRESS:

CITY: STATE: ZIP: BIRTHDATE:

WORK PHONE: HOME/CELL PHONE:

E-MAIL:

EMERGENCY CONTACT: PHONE: PREFERED METHOD OF CONTACT: E-Mail Home Phone Cell Phone Work Phone

I am interested in serving as a (and have signed the attached contract for) Girls on the Run:___ Head Coach (open to women only, 5 hr/week)___ Assistant Coach (4 hr/week)___ Running Buddy on 5K practice days and for the final 5K Fun Run (5-10 hr total)

I prefer to coach Girls on the Run:___Mondays and Wednesdays, 2-4 pm___Tuesday and Thursdays, 2-4 pm

2014 is a very special GOTR season! Molly Barker, founder of GOTR, will be visiting Sitka for our 5K in May. We’d like to make this event bigger and better than ever and need YOUR help and ideas to make that happen!

Yes, I would also like to volunteer on the 5K Planning Committee!

Girls on the Run Coach InformationPlease provide short answers so we can get to know you!

1. How did you hear about Girl on the Run of Southeast Alaska?___Radio/Facebook/Poster ___Website___Friend, please share their name with us so we can thank them: ___Employer ___Other:

2. What is your experience working with children, specifically in 3rd-5th grades?

3. Please share special skills you possess that would be of value to Girls on the Run!

4. Name one of your personal strengths and one personal challenge, especially around working with youth.

5. Why is working with young girls important to you?

8. Why would you be a good role model for these girls?

9. What is your coaching or running buddy style?

11. Please list two individuals who can serve as references for you and your character:Name Contact Information Relationship to you

2014 Season, Girls on the Run of Southeast Sitkans Against Family Violence P.O. Box 6136, Sitka, AK 99835

907-747-3370 / [email protected] P a g e | 2

Girls on the RunHealth History Form

Instructions: Coach must complete this form and return prior to volunteer placement.NAME:AGE:BIRTH DATE:TODAY’S DATE:

Please check if you have a history with any of the following:___ 1. Heart disease or heart problems___ 2. Hypertension or high blood pressure___ 3. Stroke___ 4. Diabetes or abnormal blood sugar test___ 5. Epilepsy or seizures___ 6. Abnormal Chest X-ray___ 7. Asthma or Allergies (if yes, does participant use an inhaler?)

___________________________________________________________________ 8. Orthopedic or muscular problems___ 9. Any other or Allergies (if yes, please describe)

___________________________________________________________________ 10. Do you use prescription drugs (if yes, please list drugs)___________________________________________________________________ 11. Do you live with or spend a lot of time with someone who smokes?

___ 12. Do you have close relatives (mother, father, sibling) with a history or heart disease?

Who should we contact in case of emergency?Name: Phone:Name: Phone:

Who is your primary physician?Name: Phone:

Insurance Information Are you covered by family medical/hospital insurance? Yes NoIf yes, indicate carrier or plan name:Group#:Carrier address:Name of insured:Relationship to participant:

PERMISSION TO PROVIDE NECESSARY TREATMENT OR EMERGENCY CARE:I hereby give permission to Girls on the Run to provide transportation and obtain medical care for me in the event of an emergency. In the event that my emergency contact cannot be reached in an emergency, I hereby give permission to the healthcare provider selected by fellow Girls on the Run staff to secure and administer treatment, including hospitalization.

SIGNATURE: Date:



Girls on the RunNon-Compete Cause

I, ________________________________(print), as a volunteer of GOTR Southeast Alaska agree to the following:

1. I will not deliver the Girls on the Run International program or any similar program unless I am working as an employee or volunteer of a Girls on the Run Council.

2. I may not create or help develop a program that has similar goals and structure to that of Girls on the Run International within a two-year period of my involvement with GOTR of Southeast Alaska.

3. I understand that all printed materials given to me are under copyright and may not be reproduced in any way unless written permission is received.

4. I will abide by the logo usage guidelines and obtain approval from Girls on the Run International staff if I am unsure of its use.

_______________________________________ __________________ Girls on the Run Volunteer Signature Date

Program Participation Photo Release During the program we occasionally take photos and videos of the coaches, volunteers, and girls. With your permission given herein, we may use these photos and videos for future brochures, publications, websites, or registration and testing information about participants to the national office of Girls on the Run.

Role ModelGirls on the Run volunteers are role models for our participants. Therefore, all must be drug and tobacco-free during the program and must not consume excessive amounts of alcohol. In addition, if a Girls on the Run coach has been treated for any addiction (including, but not limited to, eating disorders, alcohol or drug use), that coach must have successfully completed treatment at least one year prior to the date signed below. Girls on the Run of Southeast Alaska reserves the right to dismiss volunteers for violations of this policy. By signing below, you solemnly swear that you are abiding by all of the above policies and the terms set forth in the job description.

Authorization I have read this form and understand there is inherent risk associated with physical activity. To the best of my knowledge there are no contraindications to my participation in the Girls on the Run program. By my signature below, I give permission for my participation in this program.

_______________________________________ __________________ Girls on the Run Volunteer Signature Date



Girls on the RunBackground Check and Fingerprint Requirements

*All volunteers working with participants (coaches and running buddies) MUST have a background check and fingerprinting prior to the season start, per Girls of the Run of Southeast Alaska’s policies.

--Background checks for GOTR are done through AWARE, Inc, the Girls on the Run of Southeast Alaska partner in Juneau. All volunteers must fill out AWARE’s form to run this background check. If you have a current background check through working or volunteering elsewhere in Sitka, you can provide a copy of that background check instead of filling out AWARE’s form.

--If you have been fingerprinted within the past two years by a current or previous employer, you are exempted from going through the process for GOTR if you can provide a copy of the fingerprint report for our files. If you cannot get a copy, you may sign the fingerprinting exemption form below for your coach file.

Fingerprinting Exemption

I ____________________________ verify that I have been fingerprinted as a

current OR past employee (within the last two years) of _______________________________.

In signing this exemption I am also swearing that I have never been accused, arrested for, or convicted of an act of violence against another adult or a child.

Signature

Date



Name (please print)

Employer

AWARE, Inc.Release of Information and Background Check Authorization

Please complete the following:

Last Name First Middle___________________

Other Names Used:

Social Security # Date of Birth

Driver’s License # State of Driver’s License

Current Physical Address How Long At Current Address:

Prior Physical Addresses (last 5 years) How Long Resided There:

Employment [ ] Volunteer [ ] GOTR Volunteer [ ]

I understand that it is necessary for Aiding Women in Abuse and Rape Emergencies, Inc. (AWARE, Inc.) to conduct a criminal and child protection background check on me as part of the screening process for employment. I give permission for AWARE, Inc. to receive this information from LexisNexis, the applicable Police Department, the Alaska State Troopers, the District Attorney’s Office, the Federal Bureau of Investigation, and or Courtview.

Signature of Applicant: Date:

Signature of Witness: Date:



Girls on the Run Head Coach Job DescriptionAn agreement with GOTR of Southeast Alaska

Head Coaches are the backbone of the Girls on the Run program! You’ll feel a sense of accomplishment that you have made a difference in the lives of the girl, be the leader of a team of coaches, get to know the curriculum and program first hand, and have a ton of fun with your team!

Head Coach Job DescriptionThe Head Coach is a volunteer position that works with a team of coaches to facilitate the Girls on the Run Southeast curriculum to program participants. This position works closely with the SAFV GOTR Coordinator and entails approximately 4-5 hours per week with additional time required on weekend days for a free training on January 25th; a 5K race event on May 11th; and for First Aid/CPR training, provided as needed.

Core Duties/Responsibilities of a Head Coach-Understand and believe in the mission of the organization including acting as spokesperson for the program. -Serve as a role model/mentor. -Adhere to all policies & procedures of GOTR, as provided to me in my Coach Binder. -Come to all practices prepared, organized and ready to supervise the weekly lessons. -Lead the program participants through each lesson. -Collect attendance at each practice. -Complete the pre/post evaluations with all students. -Turn in all attendance records and pre/post evaluations to SAFV GOTR Coordinator. -Submit pertinent data to SAFV GOTR Coordinator as requested (which may include weekly submissions). -Attend all coaches meetings unless previous arrangements have been made with the SAFV GOTR Coordinator. -Interact with parents of programs participants; help to coordinate their participation in end of the season events. -Attend the end of season community 5k event with program participants and other volunteers.

As a Head Coach I hereby agree to the following: I understand that by choosing to participate in the GOTR training program I will act as a head coach for the 2014 GOTR Sitka season. I will strive to uphold the goals and objectives of GOTR of Southeast Alaska and do my best to maintain participant engagement for GOTR in my community. In the event I encounter a barrier or problem, or will not be able to attend a practice because of illness or emergency conflicts, I agree to seek the guidance of the SAFV GOTR Coordinator immediately. Additionally, if I am unable to fulfill my duty as a head coach I will immediately provide the SAFV GOTR Coordinator with a written statement including a replacement coach and a plan to train the replacement coach before I relinquish my duties.

I recognize the importance of my position and will adhere to all expectations to the best of my ability. I will strive to always remember the core values of GOTR Southeast. My signature below indicates that I agree to uphold the terms and responsibilities stated above.

___________________________________________ ___________________________ Coach Signature Date



Girls on the Run Assistant Coach Job DescriptionAn agreement with GOTR of Southeast Alaska

Serving as an Assistant Coach is fun and rewarding way to get involved with Girls on the Run and learn more about our program! You get to experience the program first hand, feel a sense of accomplishment that you have made a difference in the lives of the girl, and have a ton of fun with your team of coaches and incredible girls!

Assistant Coach Job DescriptionThe Assistant Coach is a volunteer position that assists the Head Coach(es) at Girls on the Run program site. The position entails approximately 1.5-3 hours per week. Assistant Coaches can choose to attend both program sessions per week or commit to only one day a week. We ask Assistant Coaches to determine which schedule works best for them and to maintain that schedule throughout the program for consistency on behalf of the girls. While the Assistant Coach is not primarily responsible for facilitating the Girls on the Run curriculum, they are there to support the Head Coach, teach curriculum as they desire, and engage with program participants. Assistant Coaches’ time is also required on weekend days for a free training on January 25th and a 5K race event on May 11th.

Core Duties/Responsibilities of an Assistant Coach -Understand and believe in the mission of Girls on the Run.-Serve as a role model and mentor for program participants.-Attend program session on selected day(s) on a consistent basis.-Assist with all aspect of the facilitation of Girls on the Run curriculum.-Attend coaches meetings in absence of head coach.-Encourage and cheer for all participants.-Participate in games and workouts with the girls as needed by the coaches.-Attend a community 5k with coaches, program participants and other volunteers.-Other duties as assigned.

As an Assistant Coach I hereby agree to the following: I understand that by choosing to participate in the GOTR training program I will act as an assistant coach for the 2014 GOTR Sitka season. I will strive to uphold the goals and objectives of GOTR of Southeast Alaska and do my best to maintain participant engagement for GOTR in my community. In the event I encounter a barrier or problem, or will not be able to attend a practice because of illness or emergency conflicts, I agree to seek the guidance of the SAFV GOTR Coordinator immediately. Additionally, if I am unable to fulfill my duty as an assistant coach I will immediately provide the SAFV GOTR Coordinator with a written statement including a replacement coach and a plan to train the replacement coach before I relinquish my duties.


___________________________________________ ___________________________ Coach Signature Date



Girls on the Run Running Buddy DescriptionAn agreement with GOTR of Southeast Alaska

Serving as Running Buddy for GOTR is fun and rewarding way to get involved with Girls on the Run with a low time commitment. You can learn more about the program and support the coaches and girls during their longer running practices and during the 5K!

Running Buddy Job DescriptionThe Running Buddy is a volunteer position that assists the Coach team at Girls on the Run program site. The position entails approximately three 1.5 hour practices during the season, as well as participation in the 5K race event on May 11th. Running Buddies will work with the GOTR Sitka Coordinator and Coaching teams to determine which practices to visit at the beginning of the season. Running Buddies will also be “on call” to fill in for sick or unavailable coaches, as their schedule allows. Running Buddies are not responsible for facilitating the Girls on the Run curriculum, so they can focus on supporting and engaging with program participants. Running Buddies are encouraged to attend a free training on January 25th.

Core Duties/Responsibilities of a Running Buddy -Understand and believe in the mission of Girls on the Run.-Serve as a role model and mentor for program participants.-Attend program session on selected day(s).-Encourage and cheer for all participants.-Participate in games and workouts with the girls as needed by the coaches.-Support coaches as needed when attending practices.-Attend a community 5k with coaches, program participants and other volunteers.-Be on call to fill in for coaches, as available (if I attend the coaches training).-Other duties as assigned.

As a Running Buddy I hereby agree to the following: I understand that I am committing to participate as a running buddy for the 2014 GOTR Sitka season. I will strive to uphold the goals and objectives of GOTR of Southeast Alaska and do my best to maintain participant engagement for GOTR in my community. In the event I encounter a barrier or problem, or will not be able to attend a scheduled practice because of illness or emergency conflicts, I agree to seek the guidance of the SAFV GOTR Coordinator immediately. Additionally, if I am unable to fulfill my duty as a running buddy I will immediately provide the SAFV GOTR Coordinator with a written statement and attempt to find a replacement running buddy.


___________________________________________ ___________________________ Running Buddy Signature Date



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