Due to Increased Security Measures on the Naval Support Activity (NSA) Installation In
§ Due to increased security measures on the Naval Support Activity (NSA) Installation in Mechanicsburg, we are requiring ALL volunteers and ALL persons accompanying the athletes and/or attending the event to submit the requested information by the due date listed below. Failure to submit the completed attached form in the allotted timeframe will result in denial of access to the NSA Installation.
§ Entrance to the NSA Installation is ONLY permitted through the Main Gate off of Route 581 (5450 Carlisle Pike).
§ Buddies will be assigned a specific athlete ahead of time. If you already have an athlete in mind, please request his/her name on the attached form.
RETURN FORM BY APRIL 3, 2015 TO:
Andre Harrell, Code N 97122, NAVSUP-WSS, Building 311-2,
5450 Carlisle Pike,
P.O. Box 2050
Mechanicsburg, PA 17055-0788
OR FAX TO: 717-605-1225
KEEP THIS INFORMATION AS A REMINDER OF THE REQUIREMENTS FOR DAY OF THE EVENT
§ You must present a valid picture identification.
§ The Guards will NOT grant access to anyone whose name is not on the attendance list. Therefore, it is important that you submit the requested information by the due date.
§ Vehicles are subject to inspection on the NSA Installation.
§ Parking is limited to the designated areas. You will be directed to the parking area upon arrival.
§ NSA Installation access will be confined to the event areas ONLY.
§ Pursuant to the Internal Security Act, Alcohol, Drugs and Weapons are NOT permitted on the NSA Installation.
§ Under the current Force Protection Conditions, the NSA Installation can host this event. Should the current status change, the Adult Special Olympics may need to be relocated or cancelled. Notification will be made to AM 580, WHP Harrisburg Radio; FM 104 WNNK Harrisburg Radio; WITF Radio; TV ABC Ch. 27; TV WGAL Ch. 8; TV WHP Ch. 21; and Fox TV Ch. 43.
1. Volunteer/Escort Information
FULL NAME: ______
DATE OF BIRTH: ______
___ Athlete Escort (Not a Buddy) ____ Parent
___ Volunteer Worker ___ Other (Please Specify) ______
ADDRESS: ______
CITY: ______STATE: ___ ZIP: ______
TELEPHONE: ______
EMAIL: ______
(If on-base indicate Code: ______and Ext: ______)
2. Security information
Due to increased security measures on the Naval Support Activity (NSA) Installation in Mechanicsburg, we are requiring ALL volunteers and ALL persons accompanying the athletes and/or attending the event to submit the requested information by the listed due date. Failure to submit the completed attached form in the allotted timeframe will result in denial of access to the NSA Installation.
Current DOD Employees/Military Personnel: ____I have a current badge for NSA Installation access and will display it to obtain entrance to the event.
Vehicle Information
Year/Make/Model ______
License #______
3. Volunteering for: (Indicate 1st and 2nd choices)
___BUDDY ___ Photography ___ Soccer ___ Basketball ___ Registration (Athlete) ___ Softball Skills ___ Bowling ___ Registration (Volunteer) ___ Softball Throw ___ Cleanup ___ Ribbon Writing ___ Swimming ___ Long Jump ___ Setup ___ Track Events Other:______
Assigned/Requested Athlete: ______
Circle T-shirt Size: S M L XL 2X 3X 4X 5X
4. Emergency Point of Contact:
Name: ______
Phone: ______
Address: ______
______
Relationship to Volunteer: ______
5. Volunteer Signature (required by all volunteers)
I am 18 years of age or older and I understand that:
Upon request, I can be asked to submit an application for a criminal background check; the information that I have provided may be verified, and I give permission to Special Olympics to make inquiry of others concerning my suitability to act as a Special Olympics volunteer; in the course of volunteering for Special Olympics, I may be dealing with confidential information and I agree to keep said information in the strictest confidence; the relationship between Special Olympics and volunteers is an at will agreement, and that it may be terminated at any time without cause by either the volunteer or Special Olympics; I grant Special Olympics permission to use my likeness, voice, and words in television, radio, film, or in any form to promote activities of Special Olympics.
I affirm that I have read the above and that the information I have given is true and complete. (If at any time the information provided is found to have been knowingly falsified, you will be disallowed from volunteering for any program accredited by Special Olympics Pennsylvania.)
Signature: ______
Date: ______
6. Return this Form by April 3, 2015.
Mail to: Andre Harrell, Code 97122, NAVSUP-WSS, Bldg 311-2, 5450 Carlisle Pike, P.O. Box 2050, Mechanicsburg, PA 17055-0788 Or, Fax to: 717-605-1225
* Reminders for the day of the event *
You must have photo identification and your name must be on the list. Guards will not permit anyone inside the gate without either: a proper badge or a photo ID and pre-registration.
- Cars are subject to inspection
- Parking will be limited to certain areas. You will be directed where to park. Base access will be confined to the event areas only; pursuant to the internal security act, alcohol, drugs and weapons are not permitted on a military installation. (Note: cameras are permitted in the event areas only!)
Under the current force protection conditions, the installation can host this function. In the event the current status changes, games may need to be relocated or canceled. Notification will be made to AM 580 WHP Hbg. Radio; FM 104 WNNK Hbg. Radio; WITF radio; TV ABC Ch. 27; TV WGAL Ch. 8; TV WHP Ch. 21; and FOX TV Ch. 43.
***************
Contact Samad Syed, Event Director (717-605-6283), for information concerning the event.