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Alabaster Parks and Recreation Team Mom Application Questionnaire must be filled out completely .

Name _________________________________________________________________ Address________________________________________________________________ City, State, Zip__________________________________________________________ Home __________________________Cell ___________________________________ E-mail address__________________________________________________________ Sport_________________________ Which group and age do you prefer? (Circle the appropriate one): Boys Girls Age____________________________ Have you ever been convicted of a felony? Yes ___ No ___. If yes, please explain. _______________________________________________________________________ _______________________________________________________________________ __ Have you ever been convicted of a drug-related offense? Yes ____ No ____. If yes, please explain. _______________________________________________________________________ _______________________________________________________________________ __ Do you or have you used or been under the influence of a controlled substance within the last five (5) years? Yes ____ No ____. If so, when? _______________________________________________________________________ _______________________________________________________________________ __ Do you give the department the right to conduct a criminal background check? Yes____ No____ _______________________________________________________________________ _______________________________________________________________________ __ Is there anything else that you wish to disclose before this application is processed? _______________________________________________________________________ _______________________________________________________________________ __ Under penalty of perjury, I attest that the responses given on this application is the truth to the best of my knowledge. Signature _______________________________________ Date ___________ *Drug test may be required

*All responses are confidential and will be maintained in a locked cabinet *


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