Charles County Community Services

Charles County Community Services

New Coach’s Application

For 2014-2015Youth Leagues

NOTE: If selected, the HEAD coach will receive a 50% refund off of child’s registration fee after the first game.

(This offer is valid for one child per team that you coach.)

Name: Date:

Complete Address:

Daytime Phone Number: Evening Phone Number:

Main Contact Number: ______( This number will be placed on game schedule and rosters)

E-mail Address:

Age 21+: (circle one)Yes No (Note: A volunteer coach must be 21 years of age or older)

Coach Shirt Size:______Asst. Coach Name: Asst. Coach Shirt Size:

Coaching: (circle one) Soccer LeaguePee Wee Soccer (4 y/o)

Co-ed Basketball League Select BasketballGirl's Basketball League

Pee Wee Basketball Co-EdPee Wee Basketball GirlsYouth Volleyball

Age group you would like to coach: Soccer(6U) (8U)(10U)(12U)(14U)(16U)

Pee Wee Soccer(4 y/o)

Co-ed Basketball(7-8)(9-10)(11-12) (1314) (15-17)

Select Basketball(9-10)(11-12) (13-14) (12-14 Girls)

Girls Basketball(9-11)(12-14)

Pee WeeBasketball(5-6 co-ed)(5-6 girls)

Youth Volleyball (Grades 5-6)(Grades 7-8)

Practice: You will be able to choose your practice time and location at the coaches certification and roster pick up meeting in late November. This process will be done on a first come first serve basis. You will not be allowed to call centers and reserve time until after this meeting.

Are you interested in attending a pre-season coach’s mini-clinic? ___ yes___ no

Please indicate area you would like to coach in.

Note: Piccowaxen area is for Soccer and Co-ed Basketball Only.

North ( Waldorf,Bryantown, and Hughesville)South( LaPlata,Port Tobacco, and Charlotte Hall)

Piccowaxen (Cobb Island and Newberg)West ( Bryans Road, Indian Head, Nanjemoy, Pomfret, and Welcome)

Will you have any children participating in this program? (Circle one) Yes No If yes, please complete below:

Full Name

______

Sport

______

Age

______

Birth Date

______

Please turn form over for remaining questions

New Coach’s Application

Page 2

Please list any specific coaching experience that you may have:

Have you ever coached in any Parks & Recreation youth program? (circle one) Yes No If yes, when, which sport, and age division?

Have you ever been NYSCA certified? (circle one) Yes No If yes, list NYSCA #

When were you certified and in which sport?

(A volunteer must be certified by the National Youth Sports Coaches Association to coach in any Parks & Recreation youth league)

What influenced you to coach youth sports?

Have you ever coached in another county? (circle one) Yes No If yes, list county and sport:

Has Parks & Recreation ever run a criminal background check on you? (circle one) Yes No If yes, when and for what reason:

(A criminal background check is mandatory in order to coach in any Parks & Recreation youth league)

Personal References (persons not related to you):

NameAddressPhoneOccupation

Emergency Contact:

NameAddressHome PhoneWork Phone

I hereby acknowledge that if I am selected as a volunteer coach, I will abide by the Parks & Recreation League Guidelines. I agree to comply with all requirements of the criminal background investigation.

I authorize an investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal.

SignatureDate

Please return to:Charles County Department of Community Services, Recreation Division

8190 Port Tobacco Road, Port Tobacco, Maryland 20677

Attn: Austin Flowers, Recreation Program Supervisor

Phone: 301-934-0123 or 301-870-3388, ext. 5123

Fax: 301-934-5624