Instructions on how to complete and route the MCCS SFYS Coaching Application:
- PAGES 1-3: Please complete these formsand submit them directly back to us (Coaching Application, Coaches Code of Ethics/Touch Policy and Family Advocacy form). You do NOT need to take the Family Advocacy form to the facility to get it completed. We are authorized to process this form for you. Family Advocacy will not accept requests by an applicant to have their records processed.
- PAGE 4:Please complete the PMO Local Records Check Formand take it to your closest PMO Admin. Desk to get approved and submit it back to SFYS.
Local Records Check / Building #
Camp Foster PMO / 496
Camp Courtney PMO / 4301
Camp Kinser PMO / 520
MCAS Futenma PMO / 405
Camp Hansen PMO / 2494
Camp Schwab PMO / 3402
- PAGE 5:Please complete the Substance Abuse Formand take it to either the Behavioral Health Center on Camp Foster (Bldg. #440 next to the Chapel) or to your Unit's SACO Representative for approval and submit it back to us.
*Attention applicants stationed on Kadena Air Base!*
The procedures for your background checks are slightly different than USMC volunteers. For those on Kadena, please route your forms through Kadena Security Forces (Bldg. #705) and Family Advocacy/Mental Health Center (both in Bldg. #90).
Please ensure that all forms are signed and completed to be properly processed. An applicant may not coach within our program until all forms are processed entirely. Applications will not be considered without a completed background check form. Both Head and Assistant Coaches must provide all completed forms prior to coaching.
All of these forms must have the full SSN present to be routed otherwise; each facility will not approve these forms. If you would like, you may black out your SSN after it has been signed by the appropriate section. Please ensure the PMO/CSAC representative has signed, dated and stamped your forms prior to submission.
Once these forms are completed, you can either drop it off at our office or scan and email us the forms to:
Thank you very much for volunteering to coach!
MCCS SEMPER FIT YOUTH SPORTS COACHING APPLICATION Thank you for considering volunteering in our military community /
VOLUNTEER INFORMATION
(*Applicant must provide more than one contact number/email address. You must also provide a mailing address*)
LAST NAME: / FIRST NAME: / RANK/TITLE:
HOME PHONE: / WORK PHONE: / CELL PHONE:
EMAIL: / ALTERNATE EMAIL:
PSC MAILING ADDRESS: / ROTATION DATE: / BRANCH:
COACHING PREFERENCES
(*Age divisions may vary depending on registration numbers*)
SPORT / AGE DIVISION(check all that apply) / POSITION / AREA / PRACTICE DAYS
Co-ed Soccer
Boys Basketball
Girls Basketball
Cheerleading
/ T-Ball (ages 5-6)
Coach Pitch (ages 7-8) Boys Baseball (ages 9+)
Girls Softball (Ages 9+) / Ages 5-6
Ages 7-8
Ages 9-10
Ages 11-12 / Ages 13-14
Ages 15-16
Ages 17-18 Flexible / Head Coach
Asst. Coach
Flexible / Courtney / McT
Foster
Kinser
Flexible / Mon / Wed
Tues / Thurs
Flexible
Times: (PM)
5-6 6-7 7-8
DO YOU HAVE A HEAD OR ASSISTANT COACH YOU WOULD LIKE TO COACH WITH IF POSSIBLE?
NO IF YES, PLEASE INSERT NAME OF COACH:
DO YOU HAVE A CHILD IN THE AGE DIVISION THAT YOU ARE REQEUSTING TO COACH?
NO IF YES, PLEASE INSERT CHILD’S INFORMATION (LAST/FIRST / AGE/):
COACHING EXPERIENCE
HAVE YOU COACHED FOR MCCS SEMPER FIT YOUTH SPORTS (SFYS) OKINAWA IN THE PAST?
NO IF YES, PLEASE INSERT THE SEASON(S) YOU HAVE COACHED FOR SFYS (i.e. 2009 Soccer):
PLEASE SPECIFY ANY OTHER COACHING EXPERIENCES YOU HAVE HAD IN THE PAST OTHER THAN MCCS SFYS OKINAWA? (PLEASE INCLUDE DIVISION, LOCATION & YEAR(S):
PLEASE READ & UNDERSTAND THE FOLLOWING TERMS:
A.) In consideration of volunteering for MCCS SFYS, I agree that my likeness may be photographed or video taped and that such image be published in an outlet to promote or publicize the sports program.
B.) In consideration of volunteering for MCCS SFYS, I authorize and give consent to SFYS to obtain information regarding myself. This includes, but is not limited to: (1) a Local Records, (2) Family Advocacy, and (3) Counseling and Substance Abuse Center background check. I authorize this information to be obtained either in writing or via telephone or email in connection with my volunteer application. In the event of a positive background record check, additional justification may be required in writing from the organization.
C.) Please note that submitting an application does not guarantee a coaching position. Several factors are taken into account when selecting coaches to include but not limited to: PMO, CSAC and Family Advocacy background check results, coaching experience and good standing with any volunteer organization. If you are selected as a coach, you will be notified by either phone or email and you will be asked to attend the Coaches Meeting at that time (Coaches Meetings are for selected coaches only).
D.) I have read, understand and signed the Coaches’ Code of Ethics and MCCS Touch Policy located on the back of this form.
E.) By signing below, I agree that all information provided is true to the best of my knowledge and agree to all terms listed on this form.
PRINT NAME: ______SIGNATURE: ______TODAY’S DATE: ______
OFFICIAL USE ONLY
Coaches’ Code of Ethics
Provided by the National Youth Sports association (NYSCA)
I Hereby Pledge To Live Up To My Certification As A NYSCA Coach By Following the 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 will promise to review and practice basic first aid principles needed to treat injuries of my players.
- I will do my best to organize practices that are fun and challenging for all my players.
- 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 the skills that I teach.
- I will remember that I am a youth sport coach, and that the game is for children.
- I will read the NYSCA National Standards for Youth Sports and do everything in my power to assist all youth sports organizations to implement and enforce them.
- If an issue should develop on the field or court between coach, referees, youth, and parents, this issue should be presented to an MCCS Youth Sports representative in a calm and professional manner or prepare a clear and factual written statement to facilitate resolution and or initiate an investigation. If written, it is to be submitted to Youth Sports within two working days. If resolution is not reached, military commands, inspectors, or other outside agencies will be notified.
Touch policy
Effective 30 January 2003bY Mccs
Physical touching is an important part of the care and nurturing of youth. Youth feel loved, accepted, and supported through the sensations of touch by nurturing adults and peers. However, physical touch should be respectful of youth’s body cues and only occur with their permission. Employee, contractors, and volunteers must be sensitive to youth’s responses and requests for physical interaction, model appropriate nurturing touches. Except for safety, youth will always have the right to refuse touch. Please read the following:
- Affectionate nurturing touch is a vital for each youth’s emotional health. Affectionate nurturing touch includes shaking hands, a pat on the back, and/or a reassuring touch on the shoulder. Youth always have the right to refuse these touches.
- Touches for restraint are only used to protect the physical safely of youth and staff or to provide the least restrictive guidance necessary in a given situation. Youth are taught through modeling and verbal guidance to use words rather than physical interaction top settle their differences with others. Touches of restraint should be done as a last resort to prevent a youth from injuring him/herself or others. In addition, touches of restraint should not be done in a humiliating or harmful way.
- Inappropriate touch has a negative effect on the child, and usually involves exploitation of the child or the satisfying of an adult need at the expense of the child. An attempt to change a child’s behavior with adult physical force encourages the child to respond in kind. Examples of inappropriate touch include slapping, tickling, shaking, hitting, kissing, spanking, pinching, picking a child up by his/her arm, fondling, or molestation.
SIGNATURE: ______TODAY’S DATE: ______
5000
9E
From: Semper Fit Youth Sports Program Manager, Marine Corps
Community Services (MCCS) Division, Okinawa, Japan
To: Director, Family Advocacy Program Marine Corps Base,
Camp Smedley D. Butler, Okinawa, Japan
Subj: Authorization for release of Background Information
1. The individual listed below has applied to be a volunteer with the Youth Sports program. We request your assistance by means of a records review for any adverse information pertaining to the applicant.
Name (Last/First): / SSN:- -
Sponsor’s Name(Last/First): / Sponsor’s SSN:
- -
Branch of Service:
2. Please contact 645-3533/34 for retrieval once forms have been processed. Point of contact for these items will be Jason Kozerski, Youth Sports Director, or Natalie Steele, Youth Sports Coordinator.
Natalie M. Steele
The Below to be completed by Family Advocacy Personnel
____ No Record Found
____ Record Found
Comments:
______
Date (MM/DD/YY)Official’s Signature
UNITED STATES MARINE CORPS
PROVOST MARSHAL’S OFFICE
CAMP SMELDLEY D. BUTLER, OKINAWA
UNIT 35002
FPO AP 96373-5025
BACKGROUND RECORDS CHECK
PRIVACY ACT STATEMENT
PRIVACY ACT STATEMENT:This document falls purview to the Privacy Act of 1974. This requirement is to prevent an unwarranted disclosure to any person other than the one to whom the records or personal information pertains. Under the Privacy Act of 1974 , Reasonable care must be taken to ensure that personal information is not subject to unauthorizeddisclosure during records dissemination and disposal. Authority to request the following information is derived from 5U.S.C. 301, 10 U.S.C. 5031, Executive Order 9397, and DoD Instruction 1402.5 Implementing Public Law 101-847, Section 231, and Public Law 102-190, Section 1094.
PRINCIPLE PURPOSE: You have the right to challenge the accuracy of records under the provisions of DoD directive 5400.11
DISCLOSURE: Completion of this form is voluntary; and I hereby authorize the use of my name and social security number to be used for a background records check for the purpose of:
For the Purpose of Coaching Youth Sports
(PURPOSE FOR REQUESTING LOCAL RECORDS CHECK)
N/A
NAME (LAST, FIRST, MIDDLE) SSN RANK MOS
ORGANIZATION
DATE OF BIRTH PLACE OF BIRTH CITIZENSHIP
N/A N/A N/A N/A
CLEARANCE STATUS (DEGREE) BASIS COMPLETED BY (AGENCY) DATECOMPLETED
YOUR SIGNATURE: DATE:
The below to be filled out by PMO
RECORDS CHECK REVEALED: (Check the appropriate box)
NO RECORDS AVAILABLE.
RECORDS AVAILABLE; NO UNFAVORABLE INFORMATION INDICATED.
NOT RECOMMENDED TO WORK WITH/AROUND CHILDREN
THE FOLLOWING RECORDS:
______
______
______
***USE REVERSE SIDE OF THIS DOCUMENT IF MORE SPACE IS NEEDED***
CHECKED BY: ______
SIGNATURE: ______
DATE & TIME CHECKED: ______/______