2. First Name*
3. Last Name*
5. Address 1*
7. Address 2
8. Phone Number*
10. City
11. State
12. Zip Code
14. Email Address*
15. Are You:*

    1. Employed
    2. Student
16. Where?*
18. Position Desired*

    1. Head Coach
    2. Assistant Coach
19. Youth sport you wish to coach*

    1. Baseball (Summer)
    2. Softball (Summer)
    3. T-Ball (Summer)
    4. Flag Football (Fall)
    5. Volleyball (Fall)
    6. Basketball (Winter)
20. Another sport you wish to coach

    1. Baseball (Summer)
    2. Softball (Summer)
    3. T-Ball (Summer)
    4. Flag Football (Fall)
    5. Volleyball (Fall)
    6. Basketball (Winter)
22. Preferred Age Group*

    1. Kindergarten
    2. 1st / 2nd Grade

    1. 3rd / 4th Grade
    2. 5th / 6th Grade
23. Name of person(s) you wish to coach with (max 2):
25. Instruction/leadership experience with children (please explain):
27. Coaching education (courses, clinics, books, videos, other):
29. Previous coaching experience (organization, sport(s), age level, when):
31. Other experience as a volunteer (organization, type of service, when):
33. CPR Certified?

    1. Yes
    2. No
34. Expires
    Expires
35. First-Aid Certified?

    1. Yes
    2. No
36. Expires:
    Expires:
38. Have you ever been convicted of any criminal offense, excluding minor traffic violations?*

    1. Yes
    2. No
39. Please explain when / where:
41. Have you ever been convicted of abuse or sexually-related crimes?*

    1. Yes
    2. No
42. Have you ever been listed on a Registered Offenders database?*

    1. Yes
    2. No
43. Please explain when / where:
47. Reference 1
49. First Name*
50. Last Name*
52. Occupation*
53. Phone Number*
55. How long have you known this person?*
56. Does this person agree to be your reference?*

    1. Yes
    2. No
60. Reference 2
62. First Name*
63. Last Name*
65. Occupation*
66. Phone Number*
68. How long have you known this person?*
69. Does this person agree to be your reference?*

    1. Yes
    2. No
73. Do you have children of your own that will be participating?*

    1. Yes
    2. No
    3. Not Sure
74. Why are you volunteering?
76. What would you like to get out of this experience?
77. What is your coaching style and philosophy?
79. Are you available the following mornings?

    1. Sunday
    2. Monday

    1. Tuesday
    2. Wednesday

    1. Thursday
    2. Friday

    1. Saturday
81. Are you available the following afternoons?

    1. Sunday
    2. Monday

    1. Tuesday
    2. Wednesday

    1. Thursday
    2. Friday

    1. Saturday
83. Are you available the following evenings?

    1. Sunday
    2. Monday

    1. Tuesday
    2. Wednesday

    1. Thursday
    2. Friday

    1. Saturday
Leave This Blank:


85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit

* indicates a required field