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2. First Name*
3. Last Name*
5. Address*
7. Address Line 2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Email Address*
16. Are you:*

    1. Employed
    2. A student
17. Where?*
19. Position Desired*

    1. Head Coach
    2. Assistant Coach
20. 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)
21. 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)
23. Preferred Age Group*

    1. Kindergarten
    2. 1st / 2nd Grade
    3. 3rd / 4th Grade
    4. 5th / 6th Grade
    5. 7th / 8th Grade
24. Do you have children of your own that will be participating?*

    1. Yes
    2. No
    3. Not sure
25. Name of person(s) you wish to coach with (max 2):
27. Are you available the following evenings?

    1. Sunday
    2. Monday

    1. Tuesday
    2. Wednesday

    1. Thursday
    2. Friday

    1. Saturday
29. Are you available the following mornings?

    1. Sunday

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

    1. Sunday

    1. Saturday
32. Previous coaching experience (organization, sport(s), age level, when):
33. Instruction/leadership experience with children (please explain):
35. Coaching education (courses, clinics, books, videos, other):
36. Other experience as a volunteer (organization, type of service, when):
38. Why are you volunteering?
39. What would you like to get out of this experience?
41. What is your coaching style and philosophy?
43. CPR Certified?*

    1. Yes
    2. No
44. First-Aid Certified?

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

    1. Yes
    2. No
47. Have you ever been convicted of abuse or sexually-related crimes?*

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

    1. Yes
    2. No
50. Reference 1 First Name*
51. Reference 1 Last Name*
53. Reference 1 Occupation *
54. Reference 1 Phone Number *
56. How long have you known this person?*
57. Does this person agree to be your reference?*

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

    1. Yes
    2. No
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68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit Submit and Print

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