For Office Use Only: New

For Office Use Only: New

1st____

2nd____

$____

Return

Clinic____

$____

ATHLETIC COACH / VOLUNTEER

APPLICATION

Sport / League / Park: ______Years Certified (through 2017): ______

Head Asst.

Last Year’s Age Group/Division: ______2017Age Group Request: ______(circle one)

NAME ______

ADDRESS ______

CITY ______STATE______ZIP CODE______

PHONE NUMBERS: Home: ______Cell: ______

BIRTHDATE: ______SOCIAL SECURITY NUMBER: ______

EMAIL ADDRESS ______

PERSONAL REFERENCES (List three persons not related to you, and that do not work for the City of Florence) Name Phone Number Relationship

1. ______

1. ______

1. ______

HAVE YOU EVER BEEN CONVICTED, PLED NO CONTEST, OR FOUND NOT GUILTY OF A CRIME OTHER THAN A MINOR TRAFFIC VIOLATION?

NOTE: Conviction is not necessarily a bar to volunteering. Circumstances surrounding the conviction will be considered.

CHARGES LOCATION DATE

Volunteer Agreement

I understand and agree that any misrepresentation or omission of material information by me in this application will be sufficient cause for cancellation of this application. Furthermore, I understand that just as I am free to resign at any time, the City of Florence Recreation reserves the right to terminate my services at any time, with or without prior notice. I give the right to my employer, persons, references, organizations, and previous employers to provide any relevant information that may be required to arrive at a decision. I understand, agree to and hereby authorize a background investigation which includes a criminal records check and information from my employer, previous employers, references, organization, and persons. I acknowledge that I understand the City of Florence Athletics Policies and Procedures, Emergency Action Plan, and Guidelines to Inclement Weather. I understand that I must complete my coach’s certification and be approved by the City of Florence before I am recognized as a coach/volunteer in any of the City of Florence Athletic Programs.

EMPLOYMENT HISTORY(name of company and phone number)

Most Recent Employer and Position:

______

Dates of Employment at above employment site: From ______to ______

In the box below, please list any suggestions or special requests that you may have. All suggestions and requests are read and evaluated to improve the quality of our athletic programs.

Suggestions: Special Requests:

______

______

______

______

Ihereby pledge to follow the below NYSCA Coaches’ Code of Ethics:

• I will place the emotional and physical well being of my players ahead of a personal desire to win.

• I will treat each player as an individual, remembering the large range of emotional and physical development for the same age group.

• I will do my best to provide a safe playing situation for my players.

• I promise to review and practice basic first aid principles needed totreat injuries of my players.

• I will do my best to organize practices that are fun and challenging for all my players.

• I will lead by example in demonstrating fair play and sportsmanship to all my players.

• I will provide a sports environment for my team that is free of drugs, tobacco, and alcohol, and I will refrain from their use at all youth sports events.

• I will be knowledgeable in the rules of each sport that I coach, and I will teach these rules to my players.

• I will use those coaching techniques appropriate for all of the skills that I teach.

• I will remember that I am a youth sports coach, and that the game is for children and not adults.

Signature: ______Date: ______

City of FlorenceRecreation

City Center

324 W. Evans Street

Florence, SC 29501

Phone: (843) 665-3253

Fax: (843) 665-3264

Physical Address

513 Barnes Street

Florence, SC 29501