SNAP Helper Application

SNAP HELPER APPLICATION

Your Name
Birthday	age

Local Address	Street
	City	State:	Zip:

	Home	check best way to contact you
	Work
	Pager/cell
	Email

Permanent Address	Street
	City	State:	Zip:

	home	check best way to contact you
	work
	pager/cell
	email

Person to contact in case of emergency	Name
	Relationship
	home	check best way to contact them
	work
	pager/cell
	email

Personal References	Name
	Relationship	Phone
	Name
	Relationship	Phone
	Name
	Relationship	Phone

I heard about SNAP from
My swimming skills	Check all that apply. beginner intermediate advanced fish lifeguard taught swim lessons swim team swim for exercise
Indicate any physical limitations
List the languages you speak
Related Experience	Describe any experiences or training you’ve had with children, people with special needs, teaching, or the water
What is your motivation for working with SNAP?

Release

I understand that working in the water poses certain physical risks. I state that I am physically and emotionally capable of undertaking this work and hold SNAP and it’s agents harmless in case of injury.

_____________________________/ ___________________________ ________________

Signature Printed name Date

Photo Release

I will will not allow photos, videos, or other media gathering techniques to be taken and used for the purpose of training others and/or as a community relations resource for SNAP and/or Dori Maxon PT.

_____________________________/ ___________________________ ________________

Signature Printed name Date